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OSCE > Abdominal 2: Abdomen > Flashcards

Abdominal 2: Abdomen Flashcards

1
Q

Inspection
What do you look for?

A

Asymmetry
Abdominal distension
Scars and striae
Prominent veins - e.g. caput madusae
Hernias
Peristalsis
Cullen’s sign
Grey-Turner’s sign
Stomas
Drains

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2
Q

What are the 5 Fs of abdominal distension?

A

Fat (obesity)
Faeces (constipation)
Fetus (pregnancy)
Flatus (gastrointestinal)
Fluid (ascites)

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3
Q

What are caput medusae and what are they a sign of?

A

Distended, engorged umbilical veins radiating from umbilicus across abdomen to join systemic veins.

Sign of severe portal hypertension with portal-systemic shunting through umbilical veins

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4
Q

When is visible peristalsis seen in the abdominal examination?

A

Chronic pyloric stenosis
Intestinal obstruction

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5
Q

What is Cullen’s sign and what does it indicate?

A

Bruising around umbilicus

Haemorrhagic pancreatitis

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6
Q

What is Grey-Turner’s sign and what does it indicate?

A

Bruising in flanks

Haemorrhagic pancreatitis

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7
Q

What to check for when you see a stoma?

A

Location
Content
Spout

(stoma = spout)

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8
Q

What to check for when you see a drain?

A

Location
Content
Volume

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9
Q

What is light palpation used to assess?

A

Tenderness
Guarding

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10
Q

What is involuntary guarding a sign of?

A

Irritation of the peritoneum

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11
Q

What are the three types of tenderness?

A

Rebound tenderness
Rovsing’s sign
Murphy’s sign

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12
Q

What is rebound tenderness?

A

Slowly compress, quickly release
Pain on release

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13
Q

What is Rovsing’s sign?

A

Palpation of left iliac fossa causes right iliac fossa pain

Classically indicates appendicitis, BUT is a NON-SPECIFIC SIGN

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14
Q

What is Murphy’s sign?

A

Pain on palpation of gallblader on inspiration

Typically patient will take a sharp gasp if you reach for the right costal margin

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15
Q

What are the four abdominal quadrants?

A

RUQ
LUQ
RLQ
LLQ

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16
Q

What are the nine abdominal regions?

A

Right + left hypochondrium
Epigastrium

Right + left flank
Umbilical region

Right + left iliac fossa
Suprapubic region

17
Q

What is deep palpation used to assess?

A

Masses
- Location
- Size
- Shape
- Consistency
- Mobility
- Pulsatility

18
Q

To where does a normal liver extent from?

A

5th intercostal space
Costal margin

19
Q

Can the normal spleen be felt?

A

No
Only palpable if doubled in size - enlarges from under left costal margin towards RIF

20
Q

Can the normal kidneys be felt?

A

Not usually except thin individuals
Because they are retroperitoneal

21
Q

What might a scar in the iliac fossa indicate?

A

Kidney transplant

22
Q

What are the things to palpate in an abdominal exam?

A

Liver
Kidneys
Spleen
Aorta
Bladder

23
Q

When can the aorta be palpated?

A

Thin patients
Those with dilated aorta

24
Q

What does a pulsatile aorta mean?

A

Hands move upwards with pulsation

Normal in thin people

25
Q

What does an expansile aorta mean?

A

Hands move outwards

Indicates aneurysm

26
Q

When should you press in when palpating organs: expiration or inspiration?

A

INSPIRATION

Diaphragm flattens in inspiration, so organs move down.

27
Q

How often do bowel sounds occur?

A

Every 5-10 seconds
Listen for 30 seconds before concluding they’re absent

28
Q

What do absent bowel sounds suggest?

A

Intestinal ileus

29
Q

What do increased or ‘tinkling’ bowl sounds suggest?

A

Bowel obstruction

30
Q

What do you check for in auscultation?

A

Bowel sounds
Arterial bruits

31
Q

What do you do after IPPA in an abdominal exam?

A

Ankle and sacral oedema

Concluding remarks

32
Q

How would you complete an abdominal exam?

A

• Checking for lymphadenopathy
• Examining the hernial orifices
• Examining the external genitalia
• Performing a digital examination of the anus and rectum
• Performing a urinary ‘dipstick’ analysis

OSCE (5 decks)

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