1. Hands

The alimentary tract starts at the mouth and extends to the anus. Thus, examination includes these areas as well as the abdomen. Disease of the alimentary tract may also produce systemic effects and alimentary examination commences with the:

a) hands

b) conjunctivae and sclera, for subconjunctival pallor and jaundice

(page 16)

c) root of the neck, for supraclavicular lymphadenopathy (page 267)

d) mouth, tongue, teeth, gums and salivary glands.

Hands ( Page 7 )

In the hands (figure 1), the nails may show pallor and/or koilonychia. Clubbing may be present in chronic liver and bowel disease. Liver damage may also produce palmer erythema and spider nevi.