Abdomen Flashcards
What marks on the skin do you look for on general inspection in an abdominal exam?
Scars: hx of surgery
Tattoos: increase risk of Hep C
Significant bruises: clotting disorder/ chronic liver disease
What skin changes do you look for on general inspection in an abdominal exam?
Pallor: Anaemia: GI bleed/ malnutrition
Jaundice: Acute hepatitis, Liver cirrhosis, Cholangitis, Pancreatic Ca
Hyperpigmentation: Haemochromatosis
What broad signs do you assess on general inspection in an abdominal exam?
Young = iBD
Old = Chronic liver disease/ malignancy
Confusion: end stage liver disease= hepatic encephalopathy
Abdominal distension: Ascites/ bowel obstruction/ organomegaly
Oedema: ascites/ pedal oedema- Liver cirrhosis
Cachexia: pancreatic/ bowel/ stomach ca
Hernias: umbilical/ incisional
How does location of stoma bag indicate type?
RIF: Ileostomy
LIF: Colostomy
What medical equipment should you look for on general inspection in an abdominal exam?
Surgical drains (location + contents)
Feeding tubes
Catheters
IV access
What 3 signs should you look for on the palms in an abdominal exam?
Pallor: anaemia- GI bleeding, malnutrition
Palmar erythema:chronic liver disease, pregnancy
Dupuytren’s contracture: thickeningofpalmar fasci- alcohol related chronic liver disease. Risk: age, FHx, male, alcohol excess, diabetes
What 2 signs should you look for on the nails in an abdominal exam?
Koilonychia:spoon-shaped nails: IDA (e.g. malabsorption in Crohn’s disease).
Leukonychia:whitening of nail bed: hypoalbuminaemia (e.g. end-stage liver disease, protein-losing enteropathy).
List 4 GI related causes of clubbing
IBD
Coeliac
Liver cirrhosis
Lymphoma of Gi tract
What is indicated by asterixis?
Liver failure
What 6 signs should you look for on the arms in an abdominal exam?
Petechiae: clotting abnormalities
Haemodialysis fistula: chronic renal failure
Bruising: clotting abnormalities due to liver failure
Excoriations: Cholestasis
Needle track marks: Increased risk of viral Hepatitis
Hair loss in axilla: IDA, malnutrition
What 6 signs should you look for in the eyes in an abdominal exam?
Conjunctival pallor:anaemia.
Jaundice: Scleral icterus
Corneal arcus:< 50 suggests hypercholesterolaemia.
Xanthelasma: hypercholesterolaemia.
Kayser-Fleischer rings:Wilson’s disease.
Perilimbal injection:Anterior uveitis, associated with IBD.
What 6 signs should you look for in the mouth in an abdominal exam?
Angular stomatitis: IDA, IBD
Glossitis: Malabsorption secondary to IBD
Oral candidiasis: Immunosuppression
Aphtous ulcers: Trauma, Iron, B12, Folate deficiency, Crohns
Hyperpigmentation: Peutz Jeghers syndrome
Telangiectasia: Hereditary haemorrhagic telangiectasia
Other than JVP, what do you look for in the neck in an abdo exam?
Troisier’s sign: metastatic intrabdominal malignancy
Palpable right supraclavicular lymph node: metastatic oesophageal cancer
Acanthosis nigricans: benign, insulin resistance, GI malignancy
In which conditions may you see spider navaei?
Liver cirrhosis
Pregnancy
Give 2 causes of gynaemcomastia
Liver cirrhosis causing increased levels of circulating oestrogen
Digoxin/ Spironolactone
What causes chest hair loss in males?
Increased levels of circulating oestrogen in chronic liver disease + malnutrition
List 8 features to look for on abdominal inspection
Pulsations (expansile AAA) Stomas/ nephrostomies Scar Abdominal distension Caput medusae (portal HTN) Striae Hernias Cullens + Grey Turners sign
What are the 6 F’s of abdominal distension?
Fat Flatus Faeces Fluid Foetus Fulminant mass
What causes striae formation? List 4 examples
Tearing during rapid growth/ overstitching of skin Ascites Cushing's Obesity Pregnancy
What is indicated by Cullen’s and Grey-Turner’s sign? What is the main cause of this?
Retroperitoneal bleeding
Haemorrhagic pancreatitis
How do colostomies differ from ileostomies?
I: RIF, liquid stool, spout
C: LIF, solid stool, flush to skin
What are Lanz and Gridiron incisions used for? How do they differ?
Appendectomy
Lanz: Transverse
Gridiron: Oblique
What incision may be used for cholecystectomy?
Kochers
What may a midline incision be used for?
Laparotomy
What may a paramedian incision be used to access?
Lateral viscera (kidneys, spleen, adrenals) Rare in UK
What may a pfannenstiel incision be used for?
C section
Cystectomy
Prostatectomy
What may a Rutherford-Morrison incision be used for?
Colonic resection
What may a Chevron / rooftop incision be used for?
Oesophagectomy Gastrectomy Bilateral adrenalectomy Hepatic resections Liver transplantation
What is a Mercedes Benz incision often used for?
Liver transplantation
+ Chevron uses
How do you elicit rebound tenderness? What does this indicate?
Compress abdo wall slowly, then rapidly release = sudden sharp pain
Peritonitis
What is guarding? In what condition is it seen?
Involuntary tension in abdo muscles
Peritonitis
What is Rovsing’s sign?
Palpation of the left iliac fossa causes pain in RIF
Appendicitis
What may a cirrhotic liver feel like on palpation?
Nodular edge
What would cause hepatic tenderness?
Hepatitis
Cholecystitis (may be palpating gallbladder)
What is indicated by bilaterally enlarged ballotable kidneys?
Polycystic kidney disease
Amyloidosis
What is indicated by unilaterally enlarged ballotable kidneys?
Renal tumour
Give 2 signs indicating splenomegaly
Palpable spleen
Dull to percussion
What do tinkling bowel sounds suggest?
Obstruction
What does absence of bowel sounds suggest?
Ileus: disruption of normal propulsive ability of the intestine due to a malfunction of peristalsis.
Causes: Electrolyte abnormalities + recent abdo surgery
What do aortic or renal bruits suggest?
Aortic: AAA
Renal: Renal artery stenosis
What is the significance of pitting oedema in a GI examination?
Hypoalbunaemia:
Liver cirrhosis
Protein losing enteropathy
