Abdo

Question 1

What do you do to begin the examination?

Answer 1

Wash hands
Introduction
Identify patient
Explain and consent
Any pain?

Question 2

What do you look for on general inspection?

Answer 2

Colour (jaundice)
Perspiration
Build (wasting, obese)
Comfortable at rest
Breathing

Question 3

What hand signs are there? (8)

Answer 3

Colour (pallor = anaemia, palmar erythema = liver disease)
Temperature
Clubbing
Leukonychia (hypoalbuminaemia)
Spider naevi
Dupuytrens contracture
Asterixis (flapping tremor)

Question 4

What else do you check in the hands/arms?

Answer 4

Pulse and BP

Question 5

What do you check for in the forearms?

Answer 5

Pruritis and wasting

Question 6

What do you check for in the eyes?

Answer 6

Jaundice
Subconjunctival pallor
Xanthelasma
Corneal arcus 
Kayser-fliescher rings (Wilson’s)

Question 7

What do you look for in the face?

Answer 7

Talangiectasia

Hereditary haemorrhagic telangiectasia

Question 8

What 8 things do you look for in the mouth?

Answer 8

Telangiectasia
Pigmentation (Peutz-jegher syndrome)
Angular stomatis (b6,b12, folate or iron def)
Glossitis (b12 folate painful, iron painless)
Dehydration
Halitosis
Dental carries
Ulcers (b12, iron or chrohns or coeliac)

Question 9

What do you look for on the chest wall?

Answer 9

Spider naevi

Gyaecomastia

Question 10

What do you feel for in the neck?

Answer 10

Lymph nodes of neck and supraclavicular fossa

Question 11

What sign may you get in an intra-abdominal malignancy?

Answer 11

Trosier’s sign

Enlarged left supraclavicular lymph node due to metastatis

Question 12

What do you check for on the abdominal wall (back)

Answer 12

Scars and swellings

Question 13

How do you position patient?

Answer 13

Lie flat with one pillow

Question 14

What do you inspect the abdomen for?

Answer 14

Scars
Shape and symmetry
Movement during breathing (stops with peritonitis)
Visible swellings, masses (pulsating?) and peristalsis
Distended veins
Distension (fluid, faeces, flatus, foetus, fat)

Question 15

What are you looking for on light palpation?

Answer 15

Watch patients face

Feel for rigidity, guessing, tenderness

Question 16

What are you feeling for on deep palpation?

Answer 16

Feel for any masses

Question 17

How do you determine if masses are intra abdominal?

Answer 17

Ask the patient to raise their head and shoulders from the pillow.
Intramural abdominal masses will become less prominent when the recti contract

Question 18

What do you assess when you feel a mass?

Answer 18

Size
Surface
Shape
Edge
Consistency
Tenderness

Question 19

What organs do you palpate?

Answer 19

Liver
Spleen
Kidneys
Full bladder
Aortic and femoral pulses

Question 20

What is murphys sign and how do you illicit it?

Answer 20

Tests for an inflamed gallbladder in acute cholecystitis
Place the hand below right costal margin and ask patient to breathe in. Positive sign is pain on inspiration with no pain in left side.

Question 21

What do you percuss in the abdomen?

Answer 21

Liver (above and below resonant to dull)
Spleen (castells method)
Bladder
Shifting dullness if ascites suspected

Question 22

How do you perform castell’s method?

Answer 22

With patient in full inspiration then expiration, percuss area of lower intercostal space in left axillary line
If note goes from resonant to dull this is positive for enlarged spleen

Question 23

What do you listen for in the abdomen?

Answer 23

Are bowel sounds present, abnormal (tinkling) or absent

Aortic and femoral bruit

Question 24

What are the end-pieces to finish exam?

Answer 24

ISHRUG
inginual lymph nodes
Stools
Hernial orifices
Rectal examination
Urine dip
Genitalia

Question 25

How do you finish the exam?

Answer 25

Thank patient
Ask to redress
Wash hands