Abdominal

Question 1

What do you look for on general inspection?

Answer 1

Body habitus
Scars
Jaundice
Abdominal distension
Masses 
Pulsation
Caput medusae (portal hypertension)
Spider naevi (cirrhosis)
Gynaecomastia (alcoholism, kidney failure, liver disease)

Question 2

What do you look for in the hands?

Answer 2

Koilonychia (iron deficiency)
Leukonychia (cirrhosis, CKD, heart failure, colitis, diabetes, hyperthyroidism, iron deficiency)
Palmar erythema (cirrhosis, diabetes, thyrotoxicosis, drugs)
Dupuytren’s contracture (alcoholic liver disease)
Clubbing (cirrhosis, IBD, coeliac)
Asterixis (hepatic encephalopathy, uraemia)

Question 3

What do you look for in the axillae?

Answer 3

Acanthosis nigricans (obesity, T2DM, Cushing’s, PCOS, hypothyroidism)

Question 4

What do you look for in the face?

Answer 4

Xanthelasma (hypercholesterolaemia)
Conjunctival pallor (anaemia)
Jaundice (raised bilirubin)
Angular stomatitis, oral candidiasis, ulcers, glossitis (B12 deficiency, Crohn's, anaemia, coeliac)

Question 5

What do you palpate in the neck?

Answer 5

Lymph nodes

Virchow’s node = left supraclavicular fossa, associated with gastric malignancy

Question 6

What position should the patient be in for palpation and auscultation of the abdomen?

Answer 6

Supine

Question 7

How do you palpate the abdomen?

Answer 7

1. light palpation in 9 regions - assess for guarding or masses or patient’s expression
2. deep palpation in 9 regions - assess for rebound tenderness
3. palpate liver
4. palpate spleen
5. ballot kidneys
6. palpate abdominal aorta

Question 8

How do you percuss the abdomen?

Answer 8

1. percuss borders of liver
2. percuss borders of spleen
3. percuss bladder
4. shifting dullness (percuss to the left and mark point at which percussion note shifts from resonant to dull, patient turns to right, wait 30 seconds and percuss again, should be resonant)

Question 9

How do you auscultate the abdomen?

Answer 9

1. listen in several areas for bowel sounds
2. listen for aortic bruits
3. listen for renal artery bruits

Question 10

What more would you do to complete the examination?

Answer 10

1. examine hernial orifices
2. DRE
3. examine external genitalia

Question 11

How can you differentiate between kidneys and spleen on palpation?

Answer 11

1. Spleen moves on inspiration
2. Can’t feel superior aspect of spleen
3. Can palpate splenic notch
4. Resonant renal angle in spleen, dull in kidney