Abdominal Exam Flashcards
What do you look for when inspecting from the end of the bed
Body Habitus - Physique or body build Scars Jaundice Abdominal distension - abnormally swollen outwards Masses
What do you look for in the hands
Dorsal:
Koilonychia - spooned out soft nails
Leukonychia - white dots on nails (due to iron deficiency)
Palmar:
Erythema
Dupuytren’s contracture
(both due to liver disease)
What does asterixis indicate
Hepatic encephalopathy
Uraemia
What do you inspect the axillae for
Acanthosis Nigricans
What do you look for in the facial inspection
Eyes:
Xanthelasma (hyperlipidaemia)
Kayser-fleischer ring
(copper deposition due to Wilson’s disease)
Lower eyelid: Conjunctival Pallor (Anaemia)
Upper eye:
Jaundice (Raised bilirubin)
Mouth: Angular stomatitis (due to iron deficiency) Oral Candidiasis - white tongue Mouth ulcers Glossitis
What are causes of lymphadenopathy
Infection
Malignancy
Where is virchow’s Lymph node
Left supraclavicular fossa
Associated with gastric malignancy
What do you look for during the chest inspection
Spider Naevi
Gynaecomastia
What are the 9 regions of the abdomen (upper left to bottom right)
R. Hypochondrium
Epigastrium
L. Hypochondrium
R. flank
Umbilical Region
L. flank
Right Iliac fossa
Suprapubic region
Left iliac fossa
What do you look for during inspection of the abdomen
Scars (laparoscopy) and Striae Masses (Hernia, kidney transplant) Distension Pulsations Stomas - opening in the abdomen
What is abdominal guarding
Tensing of the abdominal walls to guard inflamed organs (upon pressure)
What does an expansile pulsating mass during aortic palpation indicate
Abdominal aortic aneurysm
What aortic pathology could you hear on auscultation
Bruit
What tests could you do to complete the exam
Examine Hernial orifices
Digital rectal exam
Examination of external genitalia if indicated
Where does the subcostal plane lie
Below the 10th rib (L3)
What is the transtubercular plane and where does it lie
Highest point of the pelvis seen from the front
Can use either the level of the iliac crest (slightly high) or the ASIS (slightly lower)
Where is the umbilicus
L3/4 of the vertebral column
Where is the transpyloric plane
L1 - half-way between the sternal notch and pubic symphysis/Xiphi and umbilicus
What organs does the transpyloric plane cross
fundus of the gallbladder Pylorus Neck of pancreas Origins of SMA Hepatic portal vein Duodenum (1st or 4th part) Kidneys - left hylum, right upper pole
What are rare signs in the abdomen
Visible peristalsis (v significant) Caput medusae (portal hypertension due to liver cirrhosis) Sister Mary Joseph's sign (metastasis in umbilicus)
2 signs of retroperitoneal bleeding:
Cullen’s sign (periumbilical bruising)
Grey turner’s (flank bruising)
What are the clinical signs of appendicitis
McBurney’s point - 1/3 distance from ASIS to umbilicus
Rovsings sign - pressure in LIf causes pain in RIf
What are the clinical signs of Cholecystitis
Murphey’s sign - Press gently beneath the R costal margin in the MCL and ask patient to breathe in. Ifthe gallbladder is inflamed the patient will feel a sharp pain
What lies in the superior 3 regions of the abdomen
Right hypochondrium:
Liver, Gallbladder, Right Kidney, SI, Ascending colon, Transverse colon
Epigastric Region:
Stomach, Liver, Pancreas, SI, Spleen, Adrenal glands, Transverse colon
Left hypochondrium:
Stomach, Left kidney, Spleen, Pancreas, part of the SI, Transverse colon, Descending colon
What lies in the middle 3 regions of the abdomen
Right Lumbar: Gallbladder, Tip of the liver, Right Colon, ascending colon, right kidney
Umbilical Region:
Umbilicus (navel), SI, Transverse Colon
Left Lumbar:
Descending Colon, Tip of the left kidney
