Abdomen Examination - Medical and Surgical Flashcards
(48 cards)
5 stigmata of chronic liver disease on hands
Leukonychia Palmar erythema Finger clubbing Flapping tremor Dupuytren's contracture
5 stigmata of chronic liver disease on hands
Leukonychia Palmar erythema Finger clubbing Flapping tremor Dupuytren's contracture
2 stigmata of chronic liver disease on face, neck or upper chest
Spider angioma (SVC drainage) Telangiectasia
Name the condition and d/dx
- Brown-to-black velvety
elevations of epidermis - Due to confluent papillomas
- Usually in axillae or neck
Acanthosis nigricans
- GI carcinomas
- GI lymphoma
- Endocrinopathies (acromegaly,
DM, others)
Name the condition and d/dx
- Slate grey or brown-bronze
pigmentation - Predominance for UV-exposed
sites eg. face
Haemochromatosis
- Hepatomegaly
- Signs of chronic liver disease
Name the condition and d/dx
- Thick skin with tense tethering
- Calcinosis
- Raynaud’s phenomenon
- Sclerodactyly
- Telangiectasia
Scleroderma
- GERD
- GI motility disorders
- Small bowel bacterial overgrowth
with malabsorption
Name the condition and d/dx
yellow discolouration of sclerae and skin
Jaundice: hyperbilirubinaemia
D/dx: prehepatic, hepatic, posthepatic
Name the condition
→ Greenish sclera
→ Xanthelasma
→ Xanthomas
→ Scratch marks
obstructive jaundice
Name the condition and d/dx
yellowish plaques in subcutaneous tissues in
periorbital region
Xanthelasmata: Indicates hypercholesterolaemia
May occur in cholestasis, esp primary biliary cirrhosis
Name the condition and d/dx
brownish-green rings at periphery of cornea
(Kayser-Fleischer rings): Indicates Wilson’s disease
Name the condition and d/dx
yellow keratinized areas on sclera
Bitot’s spot:
Indicates vitamin A deficiency
Name the condition and d/dx:
- sickly sweet smell
- fishy ammonia smell
- Putrid smell
- sickly sweet smell Fetor hepaticus (severe hepatocellular disease) or Ketosis (diabetic ketoacidosis)
- fishy ammonia smell: uraemia
- Putrid smell: anaerobic chest infection
Name the condition and d/dx
dark brown discolouration on dorsal surface of tongue
Lingua nigra:
posterior extension of filiform papillae with keratin accumulation
→ Completely benign condition
D/dx: bismuth compounds
Name the condition and d/dx
white-coloured thickening of mucosa of tongue and mouth
Leukoplakia:premalignant condition
Causes: ‘5S’
- Sore teeth (poor dental hygiene)
- Smoking
- Spirits
- Sepsis
- Syphilis
Name the condition and d/dx
smooth tongue surface ± erythema
shallow ulceration in later stages
Glossitis:
nutritional deficiencies, eg. Fe, B9, B12
- Alcoholics (common)
- Carcinoid syndrome
- Elderly people
Name the condition and d/dx
Central arteriole from which radiate numerous small vessels
On chest
Confirmation?
Spider naevus (angioma)
Confirmed by pressing on central arteriole
→ Should result in blanching of whole lesion
→ Release → rapid refilling from centre to legs
D/dx
→ Normal variation
→ Cirrhosis (esp if ≥3 or new spider naevus formation)
→ Pregnancy (2nd to 5th month)
→ Hepatitis (may occur transiently in viral hepatitis)
→ Rheumatoid arthritis
Name the condition and d/dx
enlargement of male breasts
Gynaecomastia:
D/dx:
→ Healthy adolescence
→ Chronic liver disease
→ Alcoholism
→ Chronic starvation (↓gonadotropin and testosterone production)
→ Oestrogen-secreting testicular tumours
→ Drugs, eg. spironolactone, digoxin, cimetidine
Name the condition and d/dx
Cervical lymphadenopathy
L supraclavicular node ± other cervical nodes
□ D/dx: infections (esp TB), malignancies
□ Troisier’s sign: large Lt supraclavicular (Virchow’s) node + CA stomach
Name the condition and d/dx
Scratch marks on arms, legs
generalized marks over body
generalized pruritus
may indicate obstructive jaundice, primary biliary cholangitis
Name the condition and d/dx
reddening of palms of the hands, thenar/hypothenar eminence sparing the centre
Palmar erythema:
D/dx: → Chronic liver diseases → Pregnancy → Rheumatoid arthritis → Thyrotoxicosis → Polycythaemia → Chronic febrile illness
Name the condition and d/dx
visible, palpable thickening and
contraction of palmar fascia causing permanent flexion contracture, affects 4th and 5th tendons of fingers
Dupuytren’s contracture:
Causes: → Normal, esp in manual workers → Cirrhosis, esp alcohol-related → DM → Systemic fibrosclerosing syndromes (IgG4 disease)
D/dx: G3/4 trigger finger
2 leg signs seen in chronic liver disease
□ Ankle oedema → hypoalbuminaemia
□ Ankle pigmentation ± leg ulcers
→ Associated with hypersplenism
4 abdominal signs seen in chronic liver disease
□ Hepatomegaly
□ Splenomegaly → portal hypertension
□ Ascites → portal hypertension
□ Caput medusa → portal hypertension
D/dx for abdominal distension
→ Fat: gross obesity → Fluid: ascites → Foetus: pregnancy → Flatus: gaseous distension due to bowel obstruction → Faeces → Full-sized tumours
