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Clinical > Abdo > Flashcards

Abdo Flashcards

1
Q

What is the general order of carrying out an abdo exam? (16)

A
  • WIPPEE
  • Obs around bed
  • General appearance
  • Hands and nails
  • Arms (asterixis, tremor)
  • Pulse
  • Resp rate
  • Face
  • Eyes
  • Mouth
  • Lymph nodes
  • Abdo inspection
  • Abdo palpation
  • Abdo percussion
  • Abdo auscultation
  • Legs and ankles
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2
Q

What is the position of an abdo exam?

A

Initially at 45°, totally flat later in examination

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3
Q

What level of exposure does a patient need in an abdo exam?

A

Whole upper torso (from bottom of sternum to symphysis pubis)

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4
Q

What observations can be made around the bed of an abdo patient? (10)

A
  • Oxygen masks
  • GTN spray/meds
  • Walking aids
  • Drip stand
  • Nasogastric tube
  • Snacks/nil by mouth/high cal drinks
  • Stoma bag
  • Asictis tap/drain
  • Sick bowel
  • Surgical drain
  • Catheter
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5
Q

What objects around the bed of an abdo patient should be checked? And what for?

A
  • Stoma - check the site and bag, any poo?

- Sick bowel - check vomit?

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6
Q

What could a nasogastric tube be for in an abdo patient? (2)

A
  • Suck out vomit

- Give food

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7
Q

What observations can be made about an abdo patient’s general appearance? (7)

A
  • Comfortable/in pain?
  • Unwell? Nausea?
  • Cachetic? High/low BMI? Well nourished?
  • Jaundice?
  • Pale?
  • Tattoos
  • Drug use
  • Vital signs
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8
Q

Why look for tattoos/drug use in an abdo patient?

A

Needles are a risk factor for hepatitus

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9
Q

When is it appropriate to check vital signs in an abdo patient? (2)

A
  • Suspicion of infection

- Acutely unwell

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10
Q

What should be looked for in the hands of an abdo patient? (7)

A
  • Clubbing
  • Leukonychia
  • Koilonychia
  • Palmar erythema
  • Tar staining
  • Dupurytren’s contracture
  • Capillary refill time
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11
Q

What is leukonychia?

A

White nail bed

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12
Q

What is leukonychia most commonly caused by? And what 2 conditions could this indicate?

A

Hypoalbuminemia

  • Liver failure/cirrocis
  • Enteropathy (GI disease)
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13
Q

What is kolionychia?

A

Spoon nails

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14
Q

What causes kolionychia? (3)

A
  • Chronic iron deficiency
    (hyochronic pale RBC anaemia)
  • Autoimmune diseases e.g lupus
  • Genetic
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15
Q

What are the abdo causes of clubbing?

A
  • Inflammatory bowel disease
  • Cirrhosis
  • Coeliac disease
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16
Q

What could cause palmar erythema? (2)

A
  • Liver disease

- Pregnancy

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17
Q

What could cause Dupuytren’s contracture relevant to an abdo exam? (2)

A
  • Increased alcohol usage

- Liver cirrhosis

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18
Q

What are the less common causes of leukonychia? (7)

A
  • Tramua
  • Poisoning/drugs
  • Kidney disease
  • Heart failure
  • Diabetes
  • Hyperthyroidism
  • Zinc deficiency
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19
Q

What are the less common causes of palmar erythema? (3)

A
  • Polychthaemia
  • Thryotoxcosis
  • Sarcoidosis
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20
Q

What are the abdo causes of asterixis? (3)

A
  • Hepatic encephalopathy (no liver toxin removal = build up of toxins = brain damage)
  • Uraemia (renal failure)
  • CO2 retention
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21
Q

What can tremor in the arms indicate relevant to an abdo exam?

A

Alcohol withdrawal

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22
Q

What should be looked for in the arms relevant to an abdo exam? (4)

A
  • Bruising
  • Scratch marks (excoriations)
  • Track marks
  • Tremor
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23
Q

What does bruising indicate relevant to an abdo exam?

A

Coagulation disorder due to liver failure

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24
Q

What do scratch marks indicate relevant to an abdo exam?

A

Pruritus (itch) - early sign of jaundice

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25
Q

What do track marks indicate relevant to an abdo exam?

A

IV drug use - risk for hep B and C

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26
Q

What should be checked for in the face relevant to an abdo exam?

A

Pallor

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27
Q

What should be for in the eyes relevant to an abdo exam? (4)

A
  • Jaundice
  • Conjunctival pallor
  • Kayser-Fleischer rings
  • Xanthelasma
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28
Q

How should the eyes be checked for jaundice?

A

Patient looks down and retracts upper eyelid to expose sclera - yellow?

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29
Q

What is yellow sclera known as?

A

Scleral icterus

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30
Q

What are kayser fleischer rings?

A

Copper deposits in iris best seen with a slit lamp

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31
Q

What disease to kayser fleischer rings indicate?

A

Wilson’s disease (hepatolenticular degeneration = liver can’t filter out copper)

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32
Q

What can be seen in the mouth relevant to an ado exam?

A
  • Ulcers
  • Angular stomatitis
  • Glossitis
  • Dry mucus membranes
  • Caudidal infection
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33
Q

What are rare things that can be seen in the mouth relevant to an abdo exam?

A
  • Telangectasia
  • Brown lip discolourisation
  • Purpura (burst capillary vessels in lips)
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34
Q

What is telangectasia?

A

Later

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35
Q

Later

A

Later

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36
Q

Later

A

Later

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37
Q

Later

A

Later

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38
Q

What is angular stomatitis?

A

Bilateral fissures in corners of mouth

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39
Q

What is angular stomatitis caused by? (3)

A
  • Thiamine deficiency
  • B12 deficiency
  • Iron deficiency
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40
Q

What is glossitis caused by? (3)

A
  • Folate deficiency
  • B12 deficiency
  • Iron deficiency
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41
Q

What is glossitis? (3)

A

Red swollen tongue

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42
Q

What abdo diseases cause ulcers in the mouth? (3)

A
  • Crohn’s
  • IBD
  • Coeliac disease
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43
Q

What lymph nodes should particularly be examined in the neck for an abdo exam? And where are they? (8)

A
  • Infraclavicular
  • Supraclavicular
  • Submental
  • Submanidbular (length of jaw
  • Cervical (z shaped along neck - deep to sternocleidomastoid, shallow to scalene) - anterior cervical/posterior cervical
  • Preauricular
  • Postauricular
  • Occipital
  • Axillary
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44
Q

What does lymphadenopathy in the cervical/axillary lymph nodes indicate? (2)

A
  • Infection

- Malignancy

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45
Q

What node is found in the supraclaviclar area that suggests gastric malignancy?

A

Virchow’s node

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46
Q

Where is Virchow’s node found?

A

Left superclavicular fossa

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47
Q

What is checked in a lymph exam? (4)

A
  • > 2cm = Infection/malignancy
  • Soft? Rubbery? Hard?
  • Tender vs non tender
  • Mobile/fixed?
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48
Q

What kind of lymph node would suggest malignancy? (4)

A
  • Enlarged
  • Hard
  • Fixed
  • Irregular
49
Q

What should be inspected for in the chest relevant to an abdo exam?

A
  • Spider naevi
  • Campell de Morgan spots
  • Petechial haemorrages
  • Gynaecomastia (men)
  • Hair loss
50
Q

What are spider naevi?

A

Central red spot with reddish extensions when naevus compresed

51
Q

What can spider naevi be significant for? (2)

A
  • > 5 = chronic liver disease

- Pregnancy: excess oestrogen

52
Q

What are Campbell de Morgan spots?

A

Benign 1-3 cm cherry red papules

53
Q

What are petechial haemorrages and what do they indicate?

A
  • Tiny circular non raised patches of spots (like a rash)

- Indicate straining e.g chronic coughing

54
Q

What is gynaecomastia?

A

Enlargement of breast gland in men

55
Q

What can gynaecomastia be caused by? (3)

A
  • Alcohol
  • Liver cirrhosis
  • Medications
56
Q

What medications cause gynaecomastia? (2)

A
  • Digoxin

- Spironolactone

57
Q

What are the reasons for hair loss on the chest? (3)

A
  • Malnourishment
  • Iron deficiency
  • Anaemia
58
Q

What position should the patient be in for an abdo inspection? (3)

A
  • Lie flat
  • Relax hands at sides
  • Abdo muscles relaxed
59
Q

What should be inspected for in the abdomen? (9)

A
  • Pain
  • Abdominal distension
  • Scars
  • Excoriation (stretch marks)
  • Striae (stretch marks)
  • Caput medisae
  • Pulsation
  • Stoma
  • Masses
60
Q

What scars should be inspected for in the abdomen? (3)

A
  • Midline scars
  • RIF
  • Right subcostal
61
Q

What are midline scars caused by?

A

Lapartomy

62
Q

What is a right iliac fossa scar (RIF) caused by?

A

Appendectomy

63
Q

What is a right subcostal scar caused by?

A

Cholecystectomy

64
Q

What can a central pulsatile expansile mass indicate?

A

Abdominal aortic aneurysm (AAA)

65
Q

What are caput medusae?

A

Engorged paraumbilical veins

66
Q

What are caput medusae a sign of?

A

Portal hypertension

67
Q

What are striae? And the two colours?

A

Stretch marks
Reddish/pink: new
White/silverish: chronic

68
Q

What do exocriations indicate? (2)

A
  • Cholestatsis

- Severe itching

69
Q

What are the reasons for abdominal distension? (5Fs)

A
  • Fluid (ascities)
  • Fat (obesity)
  • Faeces (constipation)
  • Flatus
  • Foetus (pregnancy)
70
Q

What do masses on abdominal inspection indicate? (2)

A
  • Organomegaly

- Malignancy

71
Q

What are the 2 places stomas can be found?

A
  • Left iliac fossa (LIF)

- Right iliac fossa (RIF)

72
Q

What is the type of stoma found at the left iliac fossa (LIF)?

A

Colostomy

73
Q

What is the type of stoma found at the right iliac fossa (LIF)? (2)

A
  • Ileostomy

- Urostomy (urine containing)

74
Q

How to prepare patient for palpation? (4)

A
  • Ask about areas of pain
  • Examine these last
  • Kneel = level with patient, eye level
  • Observe patient’s face for signs of discomfort
75
Q

What 9 regions of the abdomen that should palpated?

A
  • Right hypochondriac
  • Epigastric
  • Left hypochondriac
  • Right lumbar
  • Umblical
  • Left lumbar
  • Right iliac
  • Suprapubic
  • Left iliac
76
Q

What should be assessed in light palpation of the abdomen? (4)

A
  • Tenderness
  • Rebound tenderness
  • Guarding
  • Masses
77
Q

What is tenderness in abdominal palpation? And what should be noted? (2)

A

Pain

  • Areas involved
  • Pain severity
78
Q

What is rebound tenderness? And what does it indicate? (2)

A
  • Pain worsened on releasing the pressure

- Peritonitis

79
Q

What is guarding? And what are the two types? (2)

A
  • Involuntary tension in abdominal muscles

- Localised vs generalised

80
Q

What is guarding caused by? (2)

A
  • Inflammation of peritoneum = peritonitus

- If localised = local infection e.g appendicitis/ diverticulitis

81
Q

What is assessed in deep palpation?

A
  • Masses
82
Q

What should be assessed in abdominal masses? (6)

A
  • Site
  • Size
  • Region
  • Consistency (smooth/soft/hard/irregular)
  • Mobile? (attached to tissues)
  • Pulsatile (vascular)
83
Q

What organs should be palpated for in the abdomen? (5)

A
  • Liver
  • Gallbladder
  • Spleen
  • Aorta
  • Bladder
84
Q

How should the hand be used in palpating organs?

A

Flat edge of hand with radial side of R index finger

85
Q

How do you palpate the liver? (4)

A
  • Begin in right iliac fossa
  • Press hand into abdomen and palpate up to costal margin
  • Feel for liver edge as patient breathes in
86
Q

What should be noted about the liver edge?

A
  • Degree of extension below costal margin
  • Smooth/regular consistency?
  • Tenderness (hepatitus)?
  • Pulsatility
87
Q

What does a pulsatile liver edge indicate?

A

Tricuspid regurgitation

88
Q

Where should the liver be palpated?

A

1cm below ribcage

89
Q

What can cause a liver to be pushed down?

A

Hyperextended chest

90
Q

How should the gallbladder be palpated?

A

Right costal margin, mid claviular line (9th rib)

91
Q

Is the gallbladder usually palpable?

A

No

92
Q

What does an enlarged gallbladder indicate?

A

Obstruction to biliary flow/infection (cholecystitus)

93
Q

What does an enlarged gallbladder feel like?

A

Rounded mass moving with respiration

94
Q

What does a positive Murphy’s sign indicate?

A

Cholecystits

95
Q

Describe how to perform Murphy’s sign (5)

A
  • Patient takes deep breath
  • Gallbladder pushed down into hand
  • Patient sudden pain=stops inspiring
  • Not in left side of abdomen
96
Q

At what size does the spleen become palpable?

A

x3 normal size

97
Q

Describe how to palpate the spleen (4)

A
  • Start in right iliac fossa
  • Left costal margin
  • Right hand into abdomen as patient takes deep breath
  • Move to left hypochondrium
98
Q

Should the spleen be palpable?

A

No

99
Q

How should the kidneys be palpated? (8)

A
  • Bimanual palpation
  • Place left hand behind patients back at right flank
  • Place right hand below right costal margin
  • Press R hand fingers deep into abdomen
  • At same time press upwards with L hand
  • Patient takes deep breath
  • Ballot kidneys up and down
  • Feel lower pole of kidney moving inferiorly in inspiration
100
Q

How should the bladder be palpated? (2)

A
  • Left hand palpate down from umbilicus

- To pubic symphisis

101
Q

Should the bladder be palpable? And what does this indicate?

A

No, if it is = urinary retention

102
Q

Describe palpating the abdominal aorta (4)

A
  • Place hands either side of aortic pulsation
  • Above umbilicus
  • If outward movement = expansile = AAA
  • If upwards movement = pulsatile
103
Q

What should be assessed in percussion? (4)

A
  • Liver
  • Spleen
  • Bladder
  • Shifting dullness
104
Q

How should the bladder be percussed?

A

Suprapubic region percussed

105
Q

What is the difference between bladder and bowel percussion sounds? (2)

A
  • Bladder=dull

- Bowel=resonant

106
Q

Where should the liver border be percussed and the note change from resonant to dull?

A

5th rib to costal margin

107
Q

What does shifting dullness assess?

A

Ascities

108
Q

How is shifting dullness assessed? (7)

A
  • Percuss from centre of abdomen to flank
  • Until dullness
  • Keep finger on spot
  • Roll to opposite side
  • Keep patient there 30 secs
  • Repeat percussion in same spot
  • If dull now resonant = fluid = resonant
109
Q

What should be ausculated in the abdomen? (2)

A
  • Bowel sounds

- Bruits

110
Q

How are bowel sounds ausculated?

A

10 secs on left of umbilicus

111
Q

What do normal bowel sounds sound like?

A

Gurgling

112
Q

Give examples of abnormal bowel sounds and what they mean? (2)

A
  • Tinkling: bowel obstruction

- Absent: ileus/peritonitus

113
Q

What 2 bruits should be ausculated for in an abdo exam?

A
  • Aortic

- Renal

114
Q

Where are aortic bruits ausculated? And what is checked for?

A

Just above umblicus - AAA

115
Q

Where are renal bruits ausculated? And what is checked for?

A
  • Just above umblicus, lateral to midline

- Renal artery stenosis

116
Q

What should be checked for in the legs/feet in an abdo exam? (4)

A
  • Ischaemia
  • Pitting oedema - how far up?
  • Venous disease: ulcers, brown pigmentation, dilation
  • Erythema nodosum
117
Q

What is erythema nodosum? And what is it caused by? (2)

A
  • Tender red patches/nodules seen on both shins

- Inflammation: panniculitus

118
Q

What is erythema nodosum associated with?

A

IBD

119
Q

What further exams can be done after an abdo exam? (5)

A
  • Check hernial orifices if signs of obstruction
  • Examine external genitalia if appropriate
  • Digital rectal exam (PR) if upper GI bleed
  • Urine dip
  • Pregnancy test

Clinical (21 decks)

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