Abdo Flashcards
What do you do to begin the examination?
Wash hands Introduction Identify patient Explain and consent Any pain?
What do you look for on general inspection?
Colour (jaundice) Perspiration Build (wasting, obese) Comfortable at rest Breathing
What hand signs are there? (8)
Colour (pallor = anaemia, palmar erythema = liver disease) Temperature Clubbing Leukonychia (hypoalbuminaemia) Spider naevi Dupuytrens contracture Asterixis (flapping tremor)
What else do you check in the hands/arms?
Pulse and BP
What do you check for in the forearms?
Pruritis and wasting
What do you check for in the eyes?
Jaundice Subconjunctival pallor Xanthelasma Corneal arcus Kayser-fliescher rings (Wilson’s)
What do you look for in the face?
Talangiectasia
Hereditary haemorrhagic telangiectasia
What 8 things do you look for in the mouth?
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)
What do you look for on the chest wall?
Spider naevi
Gyaecomastia
What do you feel for in the neck?
Lymph nodes of neck and supraclavicular fossa
What sign may you get in an intra-abdominal malignancy?
Trosier’s sign
Enlarged left supraclavicular lymph node due to metastatis
What do you check for on the abdominal wall (back)
Scars and swellings
How do you position patient?
Lie flat with one pillow
What do you inspect the abdomen for?
Scars
Shape and symmetry
Movement during breathing (stops with peritonitis)
Visible swellings, masses (pulsating?) and peristalsis
Distended veins
Distension (fluid, faeces, flatus, foetus, fat)
What are you looking for on light palpation?
Watch patients face
Feel for rigidity, guessing, tenderness
What are you feeling for on deep palpation?
Feel for any masses
How do you determine if masses are intra abdominal?
Ask the patient to raise their head and shoulders from the pillow.
Intramural abdominal masses will become less prominent when the recti contract
What do you assess when you feel a mass?
Size Surface Shape Edge Consistency Tenderness
What organs do you palpate?
Liver Spleen Kidneys Full bladder Aortic and femoral pulses
What is murphys sign and how do you illicit it?
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.
What do you percuss in the abdomen?
Liver (above and below resonant to dull)
Spleen (castells method)
Bladder
Shifting dullness if ascites suspected
How do you perform castell’s method?
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
What do you listen for in the abdomen?
Are bowel sounds present, abnormal (tinkling) or absent
Aortic and femoral bruit
What are the end-pieces to finish exam?
ISHRUG inginual lymph nodes Stools Hernial orifices Rectal examination Urine dip Genitalia
How do you finish the exam?
Thank patient
Ask to redress
Wash hands
