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Medicine Y3 Placement > Abdominal Exam > Flashcards

Abdominal Exam Flashcards

1
Q

After introducing yourself what things can you comment on from the end of the bed

A

Drips, oxygen, catheter, drains, vomit bowl

body habits, well/unwell, pain, fever jaundice

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2
Q

In the peripheries what things can you comment in regards to the patients nails and what could it indicate

A
  1. clubbing - IBD or cirrhosis
  2. leuconychia (whitening of the nails due to albumin) - malnutrition, malabsorption chronic liver disease, nephrotic syndrome
  3. Koiilonychia (spooning of the nails)- iron deficiency
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3
Q

in the peripheries what things can you comment on in regards to the hands and what could it indicate

A
  1. Xanthomata-( raised yellow lesions on tendons) - hyperlipidaemia
  2. Dupuytrens contracture (thickening or contracture of the palmar fascia)- alcoholic liver disease
  3. palmar erythema- chronic liver disease or non-abdoo related
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4
Q

in the peripheries what things can you comment on in then wrist and arms and what could this indicate

A
  1. comment on the pulse (do they have an AV fistula)
  2. Flapping tremor- encepatholopathy due to liver failure
  3. Bruising as chronic liver disease may affect clotting
  4. Scratch marks due to raised urea ?
  5. Track marks or tattoos (from IVDU)
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5
Q

in the peripheries what things can you comment on in the eyes ad what could this indicate

A
  1. Yellowing of the sclera- jaundice
  2. conjuntiva pallor- anaemia
  3. corneal arcus (yellow ring overlying the iris) - hyperlipidaemia
  4. Xanthelasma- hyperlipidaemia
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6
Q

in the peripheries what things can you comment on in the mouth and what could this indicate

A
  1. Angular stomatitis & glossitis (reddening and inflammation at the sides of the mouth & swelling of the tongue) - iron, folate, B12 deficiency
  2. Ulcers - coeliac, inflammatory bowel disease, iron deficiency
  3. Factor hepaticas (musty, sweet breath) - liver failure
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7
Q

in the peripheries what things can you comment on the chest and what does this indicate

A
  1. Virchow node (left supraclavicular node) - gastric cancer
  2. Gynaecomastia (in males) - alcoholic liver disease, drugs; there are several but include DISCO (digoxin, isoniazid, spironolactone, cimetidine, oestrogen)
  3. more than 5 spider naevi - liver disease
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8
Q

What are the common drugs that can cause gynecomastia in males (DISCO)

A
  1. digoxin - glycoside
  2. Isoniazid- bacteriostatic to treat TB
  3. spironolactone- steroid drug to treat hypertension and hypertension
  4. Cimetidinie - antihistamine to treat stomach acidity and peptic ulcers
  5. Oestrogen
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9
Q

what 6 F’s can cause distention of the abdomen (stomach expansion)

A 
Fat
Fluid
Flatus 
Faeces 
Foetus 
Fucking big mass
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10
Q

what things can you comment on when inspecting the abdomen and what could this indicate

A
  1. distention- 6F’s (fat, fluid, flatus, faeces, foetus, fucking big mass)
  2. everted umbilicus with distention ( ascites)
  3. Distended abdominal veins - portal hypertension
  4. Hernias
  5. Scars and stomas
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11
Q

When palpating the 9 areas of the abdomen what does rebound tenderness and guarding mean

A

rebound tenderness - pain when you release

guarding- involuntary tension of the abdo muscles

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12
Q

How do you palpate for the liver and what can cause an enlarged liver

A

Start in RIF (right iliac fossa) and move upwards to the right costal margin
- “take a deep breath in and out, feel for liver edge on inspiration”

  • enlarged liver caused by: infective, neoplastic, cirrhotic, metabolic, toxins
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13
Q

How do you palpate for the spleen

A

start in the RIF (right iliac fossa) to the left costal margin

  • my be able to feel notch on inferior edge of the spleen to differentiate it from other masses
  • roll pt onto right hand side to ballot the spleen
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14
Q

how do you palpate the kidney

A

ballot the kidney

  • one hand behind back below lower ribs and other hand over upper quadrant
  • push hands together on expiration
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15
Q

when palpating what sign indicates cholecystitis and in what quadrant would this pain be felt

A

Murphys sign

- pain on deep palpation in the right upper quadrant only

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16
Q

How would you palpate for an abdominal aortic aneurysm

A

Expandable pulsatile mass above the umbilicus, usually enlarges to the left
- note that in slim individuals this is often felt but is not abnormal

17
Q

When percussing, which organs are you wanting to percuss

A

liver (same as palpation)
spleen (same as palpation)
Bladder (in suprapubic area)
Shifting dullness if ascites suspected

18
Q

when percussing the bladder what is the difference is sound between the bladder and a distended bowel

A

bladder : dull

distended bowel: resonant

19
Q

describe how you would carry out a shifting dullness test if you suspect ascites

A
  • percuss from midline to left flank
  • leave finger at first point of dullness
  • roll patient onto right side and leave for 30 seconds
  • if previous dull area is now tympanic then ascites is present due to fluid shift with gravity
20
Q

what things would you auscultate for in the abdomen

A

bowel sounds
renal bruit
liver bruit

21
Q

what conditions could cause the following sounds when auscultating the bowel sounds;

  • low pitched intermittent gurgling
  • tinkling/high pitched
  • loud, low pitched (borborygmus)
  • absent after listening for 2 mins at least
A
  • low pitched intermittent gurgling : normal
  • tinkling/high pitched: partial or total obstruction
  • loud, low pitched (borborygmus): diarrhoea or abnormal peristalsis
  • absent after listening for 2 mins at least : peritonitis or paralytic ileum
22
Q

Abdominal pain on palpation:

What could pain in the right hypochondriac area indicate (RH)

A

Gall stones
stomach ulcer
pancreatitis

23
Q

Abdominal pain on palpation:

What could pain in the epigastrium area indicate

A 
stomach ulcer
heartburn 
pancreatitis 
gallstones
epigastrium hernia
24
Q

Abdominal pain on palpation:

What could pain in the left hypochondria area indicate (LH)

A

stomach ulcer
duodenal ulcer
biliary colic
pancreattis

25
Q

Abdominal pain on palpation:

What could pain in the right lumbar/flank area indicate

A

Renal stones
UTI
constipation
lumbar hernia

26
Q

Abdominal pain on palpation:

What could pain in the umbilical area indicate

A 
Pancreatitis 
appendicitis (early) 
stomach ulcer
inflammatory bowel disease 
small bowel obstruction
umbilical hernia
27
Q

Abdominal pain on palpation:

What could pain in the left lumbar/flank area indicate

A

Renal stones
diverticular disease
constipation
inflammatory bowel disease

28
Q

Abdominal pain on palpation:

What could pain in the right ilia fossa RIF indicate

A

appendicitis
constipation
gynaecological pain
inguinal hernia

29
Q

Abdominal pain on palpation:

What could pain in the suprapubic area indicate

A 
UTI
appendicitis 
diverticular disease 
inflammatory bowel disease 
gynaecological pain
30
Q

Abdominal pain on palpation:

What could pain in the left iliac fossa (LIIF) area indicate

A

diverticular disease
gynaecological pain
inguinal hernia
appendicitis (+VE rovsings sign)

31
Q

what is a positive rovsigns sign in regards to appendicitis

A

If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing’s sign and may have appendicitis.

32
Q

Abdominal scars:

If patient has a Kochers scar (right side under ribs) what surgery could they have had

A

open cholecystectomy
partial liver resection
biliary surgery

33
Q

Abdominal scars:

if pt has a reverse koshers scar (left side under ribs) what surgery could they have had

A

open splenectomy

34
Q

Abdominal scars:

if pt has a midline laparotomy scar what surgery could they have had

A

upper midline: exploratory, hemicolectomy, Hartmanns, AAA

lower midline: para-umbilical hernia colectomy

35
Q

Abdominal scars:

if pt has a right paramedical laparotomy scar what could the indicate

A

various causes but rarely used in the UK

36
Q

Abdominal scars:

if pt has a mcburneys/gridiron scar what does this indicate

A

appendicectomy

37
Q

abdominal scars:

if pt has a hockey stick/rutherford morrison scar what does this indicate

A

renal transplant

38
Q

abdominal scars:

if the pt has a pfannnenstiel scar (suprapubic area) what does this indicate

A

bladder resection , prostatectomy, caesarean section, cystectomy, hysterectomy

Medicine Y3 Placement (10 decks)

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