Abdo what QS Flashcards
WHAT is the reasoning behind correct position and exposure of the patient for an abdominal examination?
Correct positon = lying flat with head on one pillow relaxes abdominal muscles to facilitate palpation
Correct exposure = visibility of abdomen from xiphisternum to suprapubic area unlikely to miss anything!
WHAT GIT‐related signs might you observe on general observation of the patient and abdomen?
Jaundice (liver disease), pallor (anaemia), bronzed (haemochromatosis), xanthomata (chronic cholestasis), mental state
(encephalopathy) ‐ Abdominal distension, striae, scars, bruising, pigmentation, localised masses, visible peristalsis
vWHAT are three (3) GIT signs you might observe in each of the following areas: nails, hands, arms, chest, back?
Nails – leukonychia, clubbing, Muehrcke’s lines and Hands – palmar erythema, Dupytren’s contracture, pallor of palmar creases
Arms – bruising, spider naevi, scratch marks
Chest – loss of chest hair and gynaecomastia in males, spider naevi and Back – bruising, spider naevi, scratch marks
WHAT is the reasoning behind observing the JVP in GIT examination?
The JVP is a measure of right atrial pressure and is raised in right‐sided heart failure which can lead to liver failure
WHAT is the significance of an enlarged LEFT supraclavicular lymph node?
The left supraclavicular lymph node, known as Virchow node, drains via the thoracic duct, abdomen, and thorax. Troisier sign is the
name given to left‐sided supraclavicular lymphadenopathy, highly suggestive of abdominal malignancy eg esophagus, stomach
WHAT is the reasoning behind asking about abdominal discomfort/pain before touching the abdomen?
In the presence of pain, start as far away as possible from its maximal site, then move systematically through the four quadrants of
the abdomen until you reach the site of maximal pain. Always remember to watch the patient’s face for discomfort at any point
WHAT does superficial palpation test for? Deep palpation?
Superficial palpation feels for any tenderness (guarding, rebound, rigidity – worsening signs of inflammation/infection – peritonitis)
Deep – may detect any organ enlargement or masses or 7Fs = Fat (obesity), Faeces (constipation), Foetus (pregnancy), Fibroids
(uterine), Flatus (gastrointestinal), Fluid (ascites) and Fatal (tumours).
WHAT three (3) things are important to do when palpating the liver edge?
Align examining hand with right costal margin beginning at right iliac fossa
b. Ask patient to breathe in = inspiration keep your index finger edge/hand pressed down feeling for possible liver edge
c. Ask patient to breathe out = expiration advance your hand 1‐2 cm upwards to feel for liver edge again on inspiration –
repeat until you reach the right costal margin
WHAT is the difference between an enlarged spleen and enlarged left kidney?
The spleen: has no palpable upper border, has a notch that may be palpable, moves inferomedially on inspiration (kidney moves
inferiorly), not usually ballotable (kidney is), has a dull percussion note (resonant over the kidney), may hear a friction rub (never
over kidney – too posterior)
WHAT is the importance of checking for AAA?
Normal width of AA is <5cm; if larger, it merits repair as rupture is a surgical emergency
WHAT would you hear when percussing for ascites, if it were present?
Early ascites (at least 2L) = a dull percussion note in the flanks; gross ascites = dullness detected closer to midline
WHAT sounds might you hear with the stethoscope placed over different areas of the abdomen?
Bowel sounds (all over), Friction rubs (liver/spleen ‐ inflammation), Venous Hums (periumbilical – portal HT), Bruits (kidney, liver,
mesenteric arteries, spleen – arterial narrowing, AV fistula)
WHAT are some causes of a solitary groin lump?
Above inguinal ligament = inguinal hernia, iliac lymphadenopathy, undescended testis, encysted hydrocele or lipoma of cord
Below the inguinal ligament = femoral hernia, lymph node, femoral artery aneurysm, psoas abscess
WHAT are three (3) GIT signs you might observe in the legs?
Peripheral oedema (liver disease), bruising (liver disease), neurological signs (chronic alcohol abuse)
