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OSCE PRATICALS > Abdomen Exam Year 2 > Flashcards

Abdomen Exam Year 2 Flashcards

1
Q

general exam for abdomen

A

General exam: 1. From the end of the bed: general demeanour, & feet to face.
General demeanour: Does the patient seem alert & oriented? well/ill? in obvious pain? Disabled? Medical equipment?
Medical equipment, drips, drains, ventilators, etc. Special food, drugs, cigarettes, bottles of alcohol etc.
Lots to look for in feet to face: oedema, is abdo distended, Obvious mass? Obvious blood vessels, pulsation, umbilicus everted? Fistulae or shunts for dialysis? Neck: obvious mass? Obvious pulsation? Obvious cyanosis or jaundice. Is face symmetrical?

Hands mouth eyes. You will now be touching the patient.

Hands: particularly clubbing, koilonychia, Dupuytrens’s contracture, leukonychia – pale nails, palmar erythema, tar stains, flapping tremor – co2 rentention.

Count pulse: is relevant to G-I tract! Shock – fast, weak, “thready” pulse.

Mouth: cyanosis, mouth ulcers, sore tongue, sore corners of mouth.

Eyes: pale mucosae – sign of anaemia, jaundiced sclerae. Also:Kayser-Fleischer rings – in wilsons disease (ring round the iris) etc.

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2
Q

kolionychia

A
  • sign of iron deficiency anaemia

- means spoon shaped nail

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3
Q

what is the pulse like in shock

A
  • fast, weak, thready pulse
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4
Q

what is erythema nodosum involved in

A

involved in chronic inflammatory bowel disease - ulcer colitis and crohns

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5
Q

what is pyoderma gangrenousum involved in

A
  • this is also involved in chronic inflammatory bowel disease - ulcer colitis and crohns
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6
Q

where does leukonychia occur in

A

occurs in albumin deficiency

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7
Q

where do you feel for lymph nodes

A
  • for abdomen feel in supraclavicular fossae epically L for virchosws node
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8
Q

what do you look for at the abdomen

A

Are they in obvious pain? Are they lying completely still? Are they writhing around?
Telangectasia on chest & abdomen.
Scars etc. Bruising, wounds, drains.
Distension.
Visible masses.
Visible pulsation.
Prominent veins on abdominal wall. Caput medusae.
Visible peristalsis
Visible masses
Wasting - not eating due to anorexia nervosa or anorexia in general, starved or malabsorption lots of reasons for this

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9
Q

what is caput medusae

A
  • these are veins trying to get from the portal circulation making it way through channels into the systemic circulation
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10
Q

how do you palpate the abdomen

A

Should be lying flat, maybe one pillow for comfort.
Ask “are you in any pain” or some such.
Quickly gently palpate the 9 areas of abdomen, to elicit tenderness, detect rigidity (guarding) & rebound tenderness.
Palpate the 9 areas again, more firmly, feeling for masses & pulsation.
If you feel pulsation, try put hands on each side & feel it pressing outwards laterally.
- normal to feel the abdominal aorta pulsation

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11
Q

how do you palpate and percuss for the liver

A

Place hand on abdomen in R iliac fossa. Ask patient to breathe in. Push hand upwards to meet descending liver. Feel either with finger tips upwards, or with lateral side of index finger upwards. About four advancing positions of the hand will be needed.

Percuss either downwards or upwards. Upper border is approximately in 5th ic space in mid-clavicular line.

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12
Q

how do you palpate and percuss for the spleen

A

Place hand in RIF. Push gently diagonally to meet spleen during inspiration. At least 4 advancing placements of the hand will be needed, finishing under L costal margin. Some people would advocate starting in L iliac fossa, & advancing upwards. The spleen must be about 3x its normal size before it is palpable.

You can roll the patient onto their R side, & put one hand on their side over the spleen, & palpate with the finger tips of the other under the costal margin. Some books suggest standing behind the patient who is rolled onto their R side & hooking the finger tips under the costal margin, but we do not recommend this.

Percuss for splenic dullness. Traube’s space (Between 6th rib to lower costal margin, between L anterior axillary line & L midclavicular line) should be resonant, becomes dull in splenomegaly. If the spleen is sufficiently enlarged to be palpable, the abdomen will be dull to percussion where the spleen is.

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13
Q

where is traubes space

A

Between 6th rib to lower costal margin, between L anterior axillary line & L midclavicular line

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14
Q

how do you feel for the kidneys

A

Ballott for each kidney with one hand in loin, & the other on anterior abdominal wall.

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15
Q

what happens to the kidneys in respiration

A
  • kidneys move slightly with respiration
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16
Q

what is ascites

A

fluid in the perineal cavity

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17
Q

how do you test for ascites

A

Shifting dullness. Percuss abdomen from centre to sides, detect when goes dull, then roll patient over & see if border has moved.

  • resonant in the middle but dull in the flanks, can test this by rolling the patient over and see if the border has moved
  • air goes to the highest part of the abdomen so you can fill the dullness shift
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18
Q

how do you listen for bowel sounds

A

Auscultate for aortic & renal artery bruits, & Iliac bruits.
Aortic bruit epigastric region just L of midline.
Renal artery bruits 3-4cms from umbilicus, 10.00 o’clock & 2.00 o’clock. - sound blood makes when it goes through obstruction
Iliac bruits on line between umbilicus & femoral pulse.

Discuss examination of groins, genitalia & per rectum.

  • if there is obstruction bowel will try and get food through this obstructive - loud bowel sounds as the food try to get through
  • can have absent bowel sounds if the bowel stops working
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19
Q

different between a bruit and murmur

A
  • if it is a heart valve it is called a murmur and stuff to do with the heart as well
  • if it is atheroma then it is called a bruit
20
Q

why is renal artery bruit important

A
  • renin increase which can lead to hypertension
21
Q

what can cause liver disease

A
  • infections - mostly viruses
  • yellow fever
  • neoplasia primary and secondary
  • chemicals such as alcohol
  • autoimmune
  • congenital
  • idiopathic
22
Q

what does portal hypertension lead to

A
  • splenomegaly
  • ascites
  • caput medusae
  • bleeding oesophageal varices
23
Q

what does liver failure lead to

A
  • bleeding
  • hypoalbuminaemia (leukonychia, ascites, oedema)
  • jaundice
  • liver flap
24
Q

what disease is associated with alcoholic liver disease

A
  • dupuytrens contracture - associated with alcoholic liver disease
  • can also be inherited
25
Q

what is clubbing associated with

A

Cirrhosis

26
Q

what can cause bleeding from the bowel

A
  • peptic ulcer of stomach & duodenum
  • inflammatory bowel disease which may be idiopathic (“autoimmune”) or infective,
  • neoplasia especially carcinoma of the stomach,
  • adenocarcinoma of the colon/rectum.
27
Q

what does bleeding high up in the bowel present as

A

-presents as melaena (foul-smelling tarry faeces

28
Q

what does bleeding low down in the bowel present as

A

bright red blood

29
Q

describe what vomiting of blood looks like

A
  • may be bright red

- dark coffee grounds

30
Q

what symptoms are associated with anaemia

A

Pallor, angular stomatitis, koilonychia

31
Q

what is the causes of bowel obstruction

A
  • within the lumen
  • within the wall
  • outside the wall
32
Q

what are the 4 signs of bowel obstruction

A
  • abdominal pain
  • vomiting
  • dimension
  • absolute constipation (no faeces)
33
Q

what are the clinical sings of bowel obstruction

A
  • tender

- loud tinkling bowel sounds unless ileum has set in

34
Q

abdominal pain causes

A
  • can be acute and chronic
  • acute abdomen is a subject in itself
  • appendicitis - typically 2-3 day history of pain moving from central abdomen to RIF, may feel sick, may have diarrhoea and or constipation, tenderness and guarding in RIF
  • peritonitis: inflammation in peritoneal cavity - Guarding, rigidity ++. Obvious pain, keep very still. Absent bowel sounds
  • colicky pain - this is where the patient cannot keep still, produced by muscular contraction in hollow organ
  • pancreatitis - acute abdomen with upper abdomen pain, shock, serum amylase is very high

Also

  • full bladder
  • gynaecological
  • obstetric causes
35
Q

how do you get peritonitis

A

-conseuqnece of perforation of the bowel or ascending infection up Fallopian tubes

36
Q

what can cause mass in the abdomen

A
  • mass - most likely neoplasm of stomach, liver, spleen, obstetric or gynaecological causes, full bladder or aneurism if pulsatile
37
Q

what pay cause a big spleen

A
  • due to portal hypertension
  • infections
  • neoplasms
  • leukaemia and myelofibrosis
  • haemolsysi
38
Q

what does the abdominal aorta present as

A
  • pulsatile mass
39
Q

describe some symptoms of crohns

A

severe mouth ulcers, clubbing, fistulae onto abdominal wall (visible), onto perineum, to other loops of bowel, into bladder, into vagina. If Crohn’s colitis may have bloody diarrhoea.

40
Q

describe some symptoms of ulcerative colitis

A
  • mouth ulcers

- bloody diarrhoea

41
Q

what do both cords and ulcerative colitis have

A

Both have lesions round anus, & anal fissures. Also anaemia & poorly nourished. Chronic inflammatory bowel disease in childhood causes failure to thrive.

Both have extra-articular manifestations: iritis, erythema nodosum, arthritis.

42
Q

what are other causes of mouth ulcers

A
  • coeliac
  • behcets
  • various skin diseases such as pemphigus
  • can be due to poor dental hygiene
43
Q

what can cause altered bowel habit

A
  • carcinoma of the colon

- inflammatory bowel disease

44
Q

what are the 5 Fs for abdominal distension

A 
1,  Fat
2, Fluid. Ascites, in ovarian cyst, in obstructed bowel.
3, Faeces. 
4, Flatus
5, Foetus
45
Q

what can cause ascites

A

Liver disease: vascular resistance plus low albumen. Cirrhosis! (T)
Portal vein occlusion (T)
Right heart failure (T)
Malnutrition (not enough protein in) (T)
Nephrotic syndrome, intestinal lymphangectasia. Protein loss! (T)
Chronic Bacterial infection esp TB (E)
Malignancy ovarian cancer, or liver, 1ary or metastatic. (E)
Pancreatitis (E)

OSCE PRATICALS (28 decks)

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