Abdo Exam - geekymedics Flashcards
What adjuncts/around the bed signs are remarkable in abdominal exam? (4)
- Feeding tubes
- Stoma bags
- Drains
- NBM
What scars may be observed?
- laparotomy
- appendectomy
- cholecystectomy
What clinical signs may be observed from the end of the bed? (7)
- jaundice - cirrhosis / hepatitis
- anaemia - GI bleeding
- abdominal distension - ascites / bowel distension / large masses
- scars
- dressings
- needle tract marks - HIV / hepatitis
- excoriations - pruritus / cholestasis
What may visible masses indicate?
- malignancy
* organomegaly
What can be inspected on the hands? (6)
- clubbing - IBD / cirrhosis / coeliac disease
- koilonychia - chronic iron deficiency
- leukonychia - hypoabluminaemia - liver failure / enteropathy
- palmar erythema - liver disease / pregnancy
- dupuytren’s contraction - alcohol excess / family history
- hepatic flap - hepatic encephalopathy / uraemia / CO2 retention
What can be inspected on the arms? (4)
- bruising - abnormal coagulation - liver failure
- petechiae - low platelets - splenomegaly
- excoriations - cholestasis
- tract marks - IV drug use - hepatitis / HIV
What can be inspected in the axillae? (3)
- lymphadenopathy - malignancy / infection
- hair loss - malnourishment / iron deficiency anaemia
- acanthosis nigricans - GI adenocarcinomas / obesity
What can be inspected in the eyes? (3)
- jaundice - haemolysis / hepatitis / cirrhosis / biliary obstruction
- conjunctival pallor - anaemia
- xanthelasma - hyperlipidaemia
What can be inspected in the mouth? (4)
- angular stomatitis - iron/B12 deficiency
- oral candidiasis - iron deficiency / immunodeficiency
- mouth ulcers - Crohn’s disease / coeliac disease
- glossitis - iron/B12/folate deficiency
What can be palpated on the neck? (2)
- cervical lymph nodes - infection / metastatic malignancy
* Virchow’s node - gastric malignancy
What can be inspected on the chest? (3)
- spider naevi - chronic liver disease (>5)
- gynaecomastia - liver cirrhosis / digoxin / spironolactone
- hair loss - malnourishment / iron deficiency anaemia
What can be inspected on the abdomen? (9)
- scars
- masses
- pulsation - AAA
- Cullen’s sign - bruising around umbilicus - retroperitoneal bleed - pancreatitis / ruptured AAA
- Grey-Turner’s sign - bruising in the flanks - retroperitoneal bleed - pancreatitis / ruptured AAA
- abdominal distension (5Fs) - fluid (ascites) / fat (obesity) / faeces (constipation) / flatus / foetus (pregnancy)
- striae - reddish/pink (new) or white/silverish (chronic) - abdominal distension
- caput medusae - engorged paraumbilical veins - portal hypertension
- stomas - colostomy (LIF) / ileostomy (RIF) / urostomy (RIF and contains urine
What can be found by light palpation of the abdomen? (4)
- tenderness
- rebound tenderness - pain is worsened on releasing pressure - peritonitis
- guarding
- masses
What features of a mass are assessed by deep palpation? (6)
- location
- size
- shape
- consistency - smooth / soft / hard / irregular
- mobility - attached to superficial or underlying tissue?
- pulsatility - may suggest vascular aetiology
If the liver edge is felted what should be noted? (4)
- degree of extension below costal margin
- consistency of the liver edge - smooth / irregular
- tenderness - suggestive of hepatitis
- pulsatility - a pulsatile enlarged liver can be caused by tricuspid regurgitation
If the gallbladder is palpable what does this suggest? (2)
- cholestasis
* cholecystitis
What does Murphy’s sign indicate?
• cholecystitis
What type of movement is suggestive of AAA?
• outward movement (expansive)
What may a palpable bladder indicate?
• urinary retention
What would be the difference in auscultation between the bladder and the bowel?
- bladder = dull
* bowel = resonant
What bowel sounds can be heard?
- gurgling = normal
- tinkling = bowel obstruction
- absent = ileus / peritonitis
What bruits may be heard?
- aortic
* renal
What further assessments and investigations should be suggested?
- check hernial orifices - if there are signs of obstruction?
- perform a PR exam - if there’s a suggestion of an upper GI bleed
- perform examination of external genitalia
