Abdo exam Flashcards
General inspection
Tattoos Bruising Total parental nutrition (TPN) Jaundice Pallor Abdo distention Stoma bag Ask patient to lift head off bed or cough to show hernia
What might bruising indicate?
Liver disease - not producing clotting factors
What would you look for in the nails?
Koilonychia - IDA due to e.g. malabsorption in Crohn’s disease, GI bleed
Leukonychia - low albumin; chronic liver disease, protein-losing enteropathy (somewhere in gut it’s lost e.g. coeliac or IBD)
What would clubbing of the fingers suggest?
IBD
Coeliac disease
Liver cirrhosis
Lymphoma of GI tract
What would you look at in the hand?
Dupuytren’s contracture
- in alcohol related chronic liver disease
Palmar erythema
- caused by increased oestrogen levels
as well as in chronic liver disease (normally breaks down oestrogen, therefore seen in excess in liver disease)
What would asterix indicate
Liver failure (hepatic enchephalopathy; build up of anaemia) Renal failure (urea increase) Respiratory failure (CO2 renetion)
What else would you inspect on the hands?
Temp
Capillary refill
Radial pulse
What is an arteriovenous fistula?
surgical connection between artery and vein
What must you never do on the fistula?
Never do venepuncture or blood pressure on the side of an AV fistula
What would you look for under the arms?
Acanthosis nigricans
- benign
- associated with insulin resistance
- GI malignancy
- feels velvety to touch
What else are you looking for in the arms?
Bruising/petechiae Excoriation marks (cholestasis; bile salts deposited in skin causing itchiness) Hair loss (IDA)
What do you look for in the neck?
JVP
Lymphadenopathy
Which lymph node are you specifically looking for?
Virchow’s node
Troisier’s sign
Palpable metastatic lymph node in left supraclavicular node
Receives drainage from intraabdominal areas therefore common sign of intraabdominal
What are two signs of high cholesterol in the eyes?
Corneal arcus
Xanthelasma
Primary biliary cholangitis (bile ducts are slowly destroyed, therefore bile builds up in liver and is deposited around the body)
What exactly is corneal arcus?
Phospholipid deposition around the eye
Jaundice in eye?
scleral icterus
Jaundice in eye?
Scleral icterus
What are you looking for in the mouth?
How hydrated is the mouth?
Fungal infection of the tongue is called?
Candidiasis
Candidiasis is commonly seen in patients with?
Patients with immunosuppression
Angular stomatitis is commonly caused by?
IDA
What do you called inflammation of the tongue?
Glossitis
Glossitis is caused by
B12 deficiency!
Ulcers of the gum are called?
Aphthous ulcers
Aphthous ulcers
Crohns
folate deficiency
IDA
Telanglectasia
Basically spider veins
Can develop GI bleeds
Hyperpigmentation
Poisiagous syndrome - associated with GI malignancy
Hyperpigmentation of lips may indicate?
Poisiagous syndrome - associated with GI malignancy
What are spider naevi caused by?
Increased oestrogen
Pregnancy
Combined oral contraceptive pill
Liver cirrhosis
Chest expansion
Scars
Spider naevi
Gynaecomastia
Abnormal hair distribution
What are you looking for on general inspection
Scars Distention Hernias Caput medusa Pulsations Cullen's and Grey Turner's sign Striae Stoma
What scar do you see with cholecystectomy?
Kocher’s scar
right side slanted
What scar do you see with liver transplant?
Mercedes benz scar
Distention may be caused by
6Fs Fluid Fat Flatulence Faeces Fetus ?
Caput medusa is caused by
Liver cirrhosis and portal hypertension
tortorous vessels that resemble the hair on medusa’s head!
What is cullen’s sign?
Rare sign
haemorrhagic pancreatitis
bruising aroudn umbilicis
What is grey turner’s sign?
Also rare sign
haemorrhagic pancreatitis bruising around flanks (laterally)
Abdo striae is caused by
Quick distension of abdo:
Cushings
Pregnancy
Ascites
Stoma
Ileostomy - right
colostomy - left e.g. after rectum has been removed
Urostomy (opening from kidneys, containing urine)
Look for:
Is there a spout?
Contents
Side
What is a stoma?
Surgical opening of bowel so that the patient
What are you looking for on light palpation?
Tenderness
If rebound tenderness is present, how would you test for this and what can it suggest
Perforation of organ
When you quickly remove your hand after light palpation,
it causes pain for the patient
Guarding can be split into
Voluntary
Involuntary
If rebound tenderness and guarding is present, what could this suggest?
Peritonitis
If there is an abdominal mass, what are you looking for?
Location Size Consistency Mobile Pulsatile
How do you palpate for the liver?
Press deeply into right flank region when patient is taking a deep breath IN
What are you feeling for besides the spleen?
Splenic notch
How do you look for the abdominal aorta?
Superior to umbilicus
place both hands gently
What would lateral expansion of the abdominal aorta indicate?
AAA aneurysm
If you find an increased mass when balloting the kidneys, what do you have to look out for?
Size and consistency
Unilateral - renal tumour
Bilateral - PKD, amyloidosis
How would you differentiate between spleen and kidney?
Kidney can be knocked between two hands whereas spleen can’t
you also can’t palpate the upper border of a spleen, whereas you can on a kidney
If there is hepatomegaly, what do you need to assess?
Size Surface edge (smooth or regular) Consistency (soft or hard) Tenderness Pulsatility
How do you palpate the spleen?
Ask patient to take a deep breath in when you palpate left side
What would pitting oedema suggest?
Hypoalbuminemiaa e.g. protein losing enteropathy liver cirrhosis heart failure renal failure
What further examinations could you suggest?
Hernial orifices
DRE
External genitalia
Urine dipstick
Why would you auscultate the liver?
To check for increased blood flow to liver
E.g. in:
Cancer
Alcoholic liver disease
