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YR3: OSCE > Abdomen > Flashcards

Abdomen Flashcards

1
Q

What marks on the skin do you look for on general inspection in an abdominal exam?

A

Scars: hx of surgery
Tattoos: increase risk of Hep C
Significant bruises: clotting disorder/ chronic liver disease

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2
Q

What skin changes do you look for on general inspection in an abdominal exam?

A

Pallor: Anaemia: GI bleed/ malnutrition
Jaundice: Acute hepatitis, Liver cirrhosis, Cholangitis, Pancreatic Ca
Hyperpigmentation: Haemochromatosis

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3
Q

What broad signs do you assess on general inspection in an abdominal exam?

A

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

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4
Q

How does location of stoma bag indicate type?

A

RIF: Ileostomy
LIF: Colostomy

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5
Q

What medical equipment should you look for on general inspection in an abdominal exam?

A

Surgical drains (location + contents)
Feeding tubes
Catheters
IV access

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6
Q

What 3 signs should you look for on the palms in an abdominal exam?

A

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

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7
Q

What 2 signs should you look for on the nails in an abdominal exam?

A

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).

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8
Q

List 4 GI related causes of clubbing

A

IBD
Coeliac
Liver cirrhosis
Lymphoma of Gi tract

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9
Q

What is indicated by asterixis?

A

Liver failure

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10
Q

What 6 signs should you look for on the arms in an abdominal exam?

A

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

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11
Q

What 6 signs should you look for in the eyes in an abdominal exam?

A

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.

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12
Q

What 6 signs should you look for in the mouth in an abdominal exam?

A

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

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13
Q

Other than JVP, what do you look for in the neck in an abdo exam?

A

Troisier’s sign: metastatic intrabdominal malignancy
Palpable right supraclavicular lymph node: metastatic oesophageal cancer
Acanthosis nigricans: benign, insulin resistance, GI malignancy

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14
Q

In which conditions may you see spider navaei?

A

Liver cirrhosis

Pregnancy

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15
Q

Give 2 causes of gynaemcomastia

A

Liver cirrhosis causing increased levels of circulating oestrogen
Digoxin/ Spironolactone

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16
Q

What causes chest hair loss in males?

A

Increased levels of circulating oestrogen in chronic liver disease + malnutrition

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17
Q

List 8 features to look for on abdominal inspection

A 
Pulsations (expansile AAA)
Stomas/ nephrostomies
Scar
Abdominal distension 
Caput medusae (portal HTN)
Striae
Hernias
Cullens + Grey Turners sign
18
Q

What are the 6 F’s of abdominal distension?

A 
Fat
Flatus
Faeces
Fluid
Foetus
Fulminant mass
19
Q

What causes striae formation? List 4 examples

A 
Tearing during rapid growth/ overstitching of skin
Ascites
Cushing's 
Obesity
Pregnancy
20
Q

What is indicated by Cullen’s and Grey-Turner’s sign? What is the main cause of this?

A

Retroperitoneal bleeding

Haemorrhagic pancreatitis

21
Q

How do colostomies differ from ileostomies?

A

I: RIF, liquid stool, spout
C: LIF, solid stool, flush to skin

22
Q

What are Lanz and Gridiron incisions used for? How do they differ?

A

Appendectomy
Lanz: Transverse
Gridiron: Oblique

23
Q

What incision may be used for cholecystectomy?

A

Kochers

24
Q

What may a midline incision be used for?

A

Laparotomy

25
Q

What may a paramedian incision be used to access?

A 
Lateral viscera (kidneys, spleen, adrenals)
Rare in UK
26
Q

What may a pfannenstiel incision be used for?

A

C section
Cystectomy
Prostatectomy

27
Q

What may a Rutherford-Morrison incision be used for?

A

Colonic resection

28
Q

What may a Chevron / rooftop incision be used for?

A 
Oesophagectomy
Gastrectomy
Bilateral adrenalectomy
Hepatic resections
Liver transplantation
29
Q

What is a Mercedes Benz incision often used for?

A

Liver transplantation

+ Chevron uses

30
Q

How do you elicit rebound tenderness? What does this indicate?

A

Compress abdo wall slowly, then rapidly release = sudden sharp pain
Peritonitis

31
Q

What is guarding? In what condition is it seen?

A

Involuntary tension in abdo muscles

Peritonitis

32
Q

What is Rovsing’s sign?

A

Palpation of the left iliac fossa causes pain in RIF

Appendicitis

33
Q

What may a cirrhotic liver feel like on palpation?

A

Nodular edge

34
Q

What would cause hepatic tenderness?

A

Hepatitis

Cholecystitis (may be palpating gallbladder)

35
Q

What is indicated by bilaterally enlarged ballotable kidneys?

A

Polycystic kidney disease

Amyloidosis

36
Q

What is indicated by unilaterally enlarged ballotable kidneys?

A

Renal tumour

37
Q

Give 2 signs indicating splenomegaly

A

Palpable spleen

Dull to percussion

38
Q

What do tinkling bowel sounds suggest?

A

Obstruction

39
Q

What does absence of bowel sounds suggest?

A

Ileus: disruption of normal propulsive ability of the intestine due to a malfunction of peristalsis.
Causes: Electrolyte abnormalities + recent abdo surgery

40
Q

What do aortic or renal bruits suggest?

A

Aortic: AAA
Renal: Renal artery stenosis

41
Q

What is the significance of pitting oedema in a GI examination?

A

Hypoalbunaemia:
Liver cirrhosis
Protein losing enteropathy

YR3: OSCE (6 decks)

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