Abdo Exam

Question 1

End of bed Abdo exam

Answer 1

Age
Confusion
Pain
Scars
Distension
Pallor
Jaundice
Hyperpigmentation (haemochromatosis)
Oedema
Cachexia
Hernia

Stoma bands
Surgical drain
Feeding tubes
Mobility aids
Charts

Question 2

Hands Abdo exam

Answer 2

LOOK:
- pallor
- palmar erythema (chronic liver disease/ pregnancy)
- dupytren’s contracture (caused by alcohol and diabetes)
- nails for koilonychia (spoon- IDA) and leukonychia (white- low albumin)

FEEL:
- clubbing (IBD, celiac, cirrhosis, lymphoma)
- temp
- radial pulse
- dupytrens contracture

MOVE:
- asterixis (hepatic encephalopathy or uraemia)

Question 3

Arms and axillae Abdo exam

Answer 3

ARMS:
- bruising (clotting- liver function)
- excoriations (cholestasis)
- needle track marks (hepatitis)

AXILLAE:
- acanthosis nigricans- benign or insulin resistance T2DM/ stomach cancer
- hair loss- IDA/ malnutrition

Question 4

Face Abdo exam

Answer 4

EYES:
- conjunctival pallor (anaemia)
- jaundice
- corneal arcus (high cholesterol)
- xanthelasma (same)
- Kayser-fleischer rings (Wilson’s)
- perilimbal injection (uveitis- IBD)

MOUTH:
- angular stomatitis (IDA)
- glossitis (B12/ folate)
- candida (immunosuppression)
- apthous ulcers (B12/folate/IDA)
- hyperpigmented macules (Peutz-Jegher’s syndrome- Polyps)

Neck for left supraclavicular lymph node (Virchow’s= intrabdo malignancy)

Question 5

Abdo inspection Abdo exam

Answer 5

• spider naevi (high estrogen, cirrhosis, pregnancy, COCP)
• gynaecomastia (high estrogen- cirrhosis)
• hair loss (malnourishment/ high estrogen)
• scars
• abdominal distension
• caput medusae (portal hypertension)
• striae (ascites, malig, Cushing,)
• Cullen’s sign (bruising around the umbilicus-> haemorrhagic pancreatitis)
• grey-turner’s sign (flank bruising also haemorrhagic panc)

Question 6

What is cullens and grey turners sign

Answer 6

Cullens= bruising around umbilicus

Grey-turners= bruising in flanks

Both late signs of haemorrhagic pancreatitis

Question 7

How to differentiate between colostomy and ileostomy stoma bags

Answer 7

Location:
- colostomies= LIF
- ileostomies= RIF

Consistency:
- colostomies= solid
- ileostomy= liquid

Spout:
- colostomies= flush to skin
- ileostomies= spout

Colostomies is colon, ileostomies is small intestine

Question 8

What is rovsing’s sign

Answer 8

Palpation of the LIF causes pain in the RIF-> unreliable indicator of appendicitis, indicates peritoneal inflammation

Question 9

What is murphy’s sign

Answer 9

Palpate liver edge then ask to take a deep breath

Is painful then cholecystitis

Question 10

5 causes of splenomegaly

Answer 10

Portal hypertension
Haemolytic anaemia
Congestive HF
Splenic metastasis
Glandular fever

Question 11

How will percussion sound change when you hit the liver

Answer 11

From resonant to dull for lower liver border

And then from dull to resonant for upper liver border

Question 12

What are you listening for when you listen to the aorta and renal arteries

Answer 12

Aortia= AAA

Renal artery= renal artery stenosis

1-2cm above umbilicus then either side