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Clinical Exams > Abdomen > Flashcards

Abdomen Flashcards

1
Q

blanket?

A

expose abdomen and offer patient blanket to allow exposure only when required and if appropriate, inform patients they do not need to remove their bra)

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2
Q

hand and nail inspection look for these conditions

A 
leuconychia
koilonychia
clubbing
palmar erythema
pale palmar creases
spider naevi
Dupytren’s contracture
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3
Q

end of bed inspection look for

A 
age
confusion
pain
obvious scars
abdominal distension
pallor
jaundice
hyperpigmentation
oedema
cachexia
hernias
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4
Q

cachexia

A

ongoing muscle loss that is not entirely reversed with nutritional supplementation

commonly associated with underlying malignancy (e.g. pancreatic/bowel/stomach cancer) and advanced liver failure

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5
Q

hyperpigmentation

A

bronzing of the skin associated with haemochromatosis

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6
Q

jaundice indicates

A

yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels (e.g. acute hepatitis, liver cirrhosis, cholangitis, pancreatic cancer)

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7
Q

abdominal distension

A

may suggest the presence of ascites or underlying bowel obstruction and/or organomegaly

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8
Q

confusion end of bed sign

A

often a feature of end-stage liver disease, known as hepatic encephalopathy

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9
Q

age in considering pathology

A

younger patients more likely to have diagnoses such as inflammatory bowel disease (IBD) and older patients more likely to have chronic liver disease and malignancy

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10
Q

objects and equipment to look for

A 
stoma bag
surgical drains
feeding tubes
mobility aids
vital signs
fluid balance
prescriptions
other equipment = ECG leads, TPN, catheters
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11
Q

INSPECT: palms of hands for

A

pallor
palmar erythema
Dupuytren’s contracture

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12
Q

INSPECT: nails for

A

Koilonychia
Leukonychia
Finger clubbing

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13
Q

check hands for asterixis

A

= flapping tremor
Ask the patient to stretch their arms out in front of them
Then ask them to cock their hands backwards at the wrist joint and hold the position for 30 seconds
Observe for evidence of asterixis during this time period

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14
Q

causes of asterixis

A 
hepatic encephalopathy (due to hyperammonia)
uraemia secondary to renal failure
CO2 retention secondary to type 2 respiratory failure
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15
Q

finger clubbing anatomy

A

loss of Schamroth’s window
loss of hyponychial angle
increased nail curvature

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16
Q

ask patient to breathe in during deep palpation when checking

A

liver and spleen

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17
Q

finger clubbing is likely to appear in these abdominal conditions

A

IBD
coeliac disease
liver cirrhosis
lymphoma of GIT

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18
Q

palmar erythema

A

= red palm

redness involving the heel of the palm that can be associated with chronic liver disease (it can also be a normal finding in pregnancy)

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19
Q

koilonychia

A

spoon-shaped nails, associated with iron deficiency anaemia (e.g. malabsorption in Crohn’s disease)

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20
Q

leukonychia

A

whitening of the nail bed, associated with hypoalbuminaemia (e.g. end-stage liver disease, protein-losing enteropathy)

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21
Q

PALPATE: hands

A

temp
radial pulse - rate and rhythm
Dupuytren’s contracture

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22
Q

Dupuytren’s contracture

A

thickening of palmar fascia > resulting in the development of cords of palmar fascia which eventually cause contracture deformities of the fingers and thumb

= when 1 or more fingers bend in towards palm

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23
Q

Dupuytren’s contracture

A

thickening of palmar fascia > resulting in the development of cords of palmar fascia which eventually cause contracture deformities of the fingers and thumb

= when 1 or more fingers bend in towards palm think nanna

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24
Q

check arms for

A

bruising - underlying clotting abnormalities secondary to liver disease
excoriations
needle track marks - IV drug use > viral hepatitis

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25
Q

excorations

A

scratch marks that may be caused by the patient trying to relieve pruritis. In the context of an abdominal examination, this may suggest underlying cholestasis

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26
Q

order of exam

A 
intro
end of bed signs
stuff around bed 
INSPECT:
hands
arm
armpit
face - eyes, mouth
neck
chest
abdomen
PALPATE abdomen
- light
- deep
- organs = liver, spleen, kidneys, bladder and aorta
PERCUSS abdomen
AUSULTATE abdomen
legs
27
Q

check armpit for

A

Acanthosis nigricans

Hair loss - iron-deficiency anaemia and malnutrition

28
Q

Acanthosis nigricans

A

darkening (hyperpigmentation) and thickening (hyperkeratosis) of the axillary skin which can be benign (most commonly in dark-skinned individuals) or associated with insulin resistance (e.g. type 2 diabetes mellitus) or gastrointestinal malignancy (most commonly stomach cancer)

29
Q

INSPECT: eyes

A 
jaundice of sclera
Kayser-Fleischer rings
conjunctival pallor
corneal arcus
xanthelasma
perilimbal injection
30
Q

INSPECT: face

A

pallor, jaundice, telangiectasia

31
Q

INSPECT: mouth

A 
Aphthous ulceration
glossitis
oral candidiasis
angular stomatitis
hyperpigmented macules
32
Q

where to check for lymphadenopathy

A

supraclavicular, axillary and inguinal lymphadenopathy.

Virchow’s node in the left supraclavicular fossa is suggestive of gastric malignancy

33
Q

left supraclavicular lymph node

A

Virchow’s node

= lymphatic drainage from the abdominal cavity and therefore enlargement of Virchow’s node can be one of the first clinical signs of metastatic intrabdominal malignancy (most commonly gastric cancer)

34
Q

right supraclavicular lymph node

A

= lymphatic drainage from the thorax and therefore lymphadenopathy in this region can be associated with metastatic oesophageal cancer (as well as malignancy from other thoracic viscera)

35
Q

Kayser-Fleischer rings

A

dark rings that encircle the iris associated with Wilson’s disease. The disease involves abnormal copper processing by the liver, resulting in accumulation and deposition in various tissues (including the liver causing cirrhosis)

36
Q

corneal arcus

A

a hazy white, grey or blue opaque ring located in the peripheral cornea, typically occurring in patients over the age of 60. In older patients, the condition is considered benign, however, its presence in patients under the age of 50 suggests underlying hypercholesterolaemia

37
Q

xanthelasma

A

yellow, raised cholesterol-rich deposits around the eyes associated with hypercholesterolaemia

38
Q

perilimbal injection

A

inflammation of the area of conjunctiva adjacent to the iris. Perilimbal injection is a sign of anterior uveitis, which can be associated with inflammatory bowel disease. Other clinical features of anterior uveitis include photophobia, ocular pain and reduced visual acuity

39
Q

Aphthous ulceration

A

round or oval ulcers occurring on the mucous membranes inside the mouth. Aphthous ulcers are typically benign (e.g. due to stress or mechanical trauma), however, they can be associated with iron, B12 and folate deficiency as well as Crohn’s disease

40
Q

glossitis

A

smooth erythematous enlargement of the tongue associated with iron, B12 and folate deficiency (e.g. malabsorption secondary to inflammatory bowel disease)

41
Q

hyperpigmented macules

A

pathognomonic for Peutz-Jeghers syndrome, an autosomal dominant genetic disorder that results in the development of polyps in the gastrointestinal tract

42
Q

Inspect chest for

A

Spider naevi
Gynaecomastia
Hair loss

43
Q

Quadrants of the abdomen

Top to bottom, right to left

A

Right hypochondrium, epigastrium, left hypochondrium
Right lumbar/flank, umbilicus region, left lumbar/flank
Right iliac fossa, suprapubic, left iliac fossa

Epigastric - stomach down to second part of duodenum, includes liver and biliary
Umbilical - down to transverse colon

44
Q

INSPECT: Abdomen for

A 
scars
symmetry and shape
lumps
distension
caput medusae
striae - Cushing's, intrabdominal malignancy
Cullen's sign
Grey-Turner's sign
peristalsis or pulsation
venous distension
discolouration
spider naevi
45
Q

palpate tips

A

Look at patients face whilst palpating to look for pain

Light palpation looks for soft/hard abdomen, tenderness, rebound, guarding

Rebound tenderness = in pain when you take your hands away, not so much when you initially press - when the abdominal wall, having been compressed slowly, is released rapidly and results in sudden sharp abdominal pain

Guarding = involuntary tension in the abdominal muscles that occurs on palpation associated with peritonitis

46
Q

Murphy’s sign

A

Get patient to breathe out
Push in deep palpate right upper quadrant
Get them to breathe in
Diaphragm goes down pushes down gallbladder

If patient stops breathing in, pause breath, sign of acute cholecystitis

Guarding with breathing

47
Q

spider naevi chest

A

skin lesions that have a central red papule with fine red lines extending radially caused by increased levels of circulating oestrogen

Commonly associated with liver cirrhosis, but can also be a normal finding in pregnancy or in women taking the COPC

If >5 are present it is more likely to be associated with pathology such as liver cirrhosis

48
Q

gynaecomastia chest

A

Enlargement of male breast tissue caused by increased levels of circulating oestrogen (e.g. liver cirrhosis). Other causes include medications such as digoxin and spironolactone

49
Q

abdominal distension 6 F’s

A 
fat
fluid
flatus (gas)
faeces
fetus
fulminant mass (severe disease)
50
Q

caput medusae

A

engorged paraumbilical veins associated with portal hypertension (e.g. liver cirrhosis)

51
Q

Inspect for hernias

A

ask patient to cough and observe for any protusions through the abdominal wall

52
Q

Cullen’s sign

A

bruising of the tissue surrounding the umbilicus associated with haemorrhagic pancreatitis (a late sign)

53
Q

Grey-turner’s sign

A

bruising in the flanks associated with haemorrhagic pancreatitis (a late sign)

54
Q

light palpation of abdomen

A

assess for tenderness, rebound tenderness, guarding, Rovsing’s sign, hernias, feel if tummy is soft or hard (bad)

55
Q

Rovsing’s sign

A

palpation of the left iliac fossa causes pain to be experienced in the right iliac fossa

56
Q

deep palpation of abdomen

A

if any masses identified, asses for the following:

  • location
  • size
  • shape
  • consistency - smooth/soft/hard/irregular
  • mobility - attached to underlying structures?
  • pulsatility - vascular
57
Q

which organs to palpate for organomegaly

A

liver, spleen, kidneys, bladder and aorta

58
Q

PERCUSS abdomen

A

liver
spleen
bladder

if ascites is suspected:
shifting dullness
fluid thrill

59
Q

shifting dullness

A

Percuss from the centre of the patient’s abdomen laterally until dullness is apparent. Keeping your finger there, then ask the patient to roll onto the opposite side. Wait for at least 30 seconds in this position, before starting to percuss. If the dullness initially detected was due to fluid, this area should now be resonant and dullness will become apparent as you continue to percuss down to the centre of the abdomen

60
Q

fluid thrill

A

Test for this by laying the flat of your left hand against the left side of the patient’s abdomen. Ask your patient to lay the flat of their hand longitudinally along the centre of their abdomen. Then tap your right hand on the right hand side of the patient’s abdomen and feel for a rippling of fluid against your left hand

61
Q

next steps following examination - end pieces

A 
examine for inguinal hernias
examine external genitalia
rectal exam/PR
measure temp
urinalysis
pregnancy test
stool sample
62
Q

AUSCULTATE: abdomen

A

listen to 2 or more parts of abdomen
listen for increased, decreased or absent (have to listen for more than 3 minutes) sounds

auscultate aorta and renal arteries to identify bruits = turbulent flow:

  • aortic bruits: auscultate 1-2 cm superior to the umbilicus, a bruit here may be associated with an abdominal aortic aneurysm
  • renal bruits: auscultate 1-2 cm superior to the umbilicus and slightly lateral to the midline on each side. A bruit in this location may be associated with renal artery stenosis
63
Q

check legs after abdomen exam for

A

pitting oedema - may suggest hypoalbuminaemia (liver cirrhosis)

Clinical Exams (3 decks)

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