ABDOMINAL EXAM Flashcards
Name 4 signs you might notice in the patient from the end of the bed which would be a clue to some abdominal pathology.
Overweight Cachexic Scars on abdomen Jaundice Dry skin Uraemic frost Calciphylaxis
Name 4 things you might notice around the patient’s bed or on the patient which would be a clue to some abdominal pathology.
Vomit bowl Nil-by-mouth sign Stoma bag Drain NG-tube Catheter
Name 4 signs you would look for in a patient’s hands as part of an abdominal examination.
Clubbing Koilonychia Leukonychia Muehrcke's lines Palmar erythema Dupuytren's contracture Pigmentation of the palmar creases
What could koilonychia be a sign of?
Hypochromic anaemia especially as a result of iron deficiency
What could leukonychia be a sign of?
Hypoalbuminemia.
This could be a sign of chronic liver disease or cirrhosis as albumin is synthesised in the liver, or nephrotic syndrome where too much protein is lost from the kidney.
NB leukonychia is quite a common sign in normal individuals. The most common cause of leukonychia is minor nail damage.
What are Muehrcke’s lines?
Muehrcke’s lines are simply widespread leukonychia. They are white lines that extend across the nail bed in parallel to the lunula (half moon). They are also a sign of hypoalbuminemia.
What is palmar erythema and what can it be a sign of? (Name 3)
Reddening of the skin over the thenar and the hypothenar eminences.
Portal hypertension Chronic liver disease (including hepatitis) Pregnancy Polycythemia Thyrotoxicity Rheumatoid arthritis Eczema
What is Dupuytren’s contracture and why might it be useful to look for as part of an abdominal exam?
In Dupuytren’s contracture, the palmar fascia within the hand becomes abnormally thick, which causes the fingers to curl and prevents full extension.
Liver cirrhosis is a recognised risk factor for Dupuytren’s contracture.
What is the medical term for ‘liver flap’?
Asterixis
Why is the presence of asterixis important to look for in an abdominal exam?
Asterixis is thought to be a sign of hepatic encephalopathy. Brain cells become damaged due to inability of liver to metabolise ammonia into urea.
What might you be looking for in the arm during an abdominal examination and what would this be an indication of?
An arteriovenous fistulae - Indicate patient has chronic kidney disease and requires dialysis.
Bruising - may suggest abnormal coagulation (↑PT) due to liver failure
Despite the fact that the abdominal exam is done with the patient lying flat, why might it be a good idea to check JVP in patient with possible abdominal pathology?
Check for fluid overload, which is possible in liver and renal dysfunction
Name 3 signs you would look for in a patient’s eyes as part of an abdominal examination.
Jaundice
Conjunctival pallor
Xanthelasma
What is jaundice and what can it be a sign of?
Yellowing of the skin and sclera due to build up of bilirubin in the blood.
Caused by: haemolysis, hepatitis, decompensated cirrhosis, biliary obstruction (gallstone, malignancy)
Name 3 signs you would look for in and around a patient’s mouth as part of an abdominal examination.
Angular stomatitis
Oral candidiasis
Mouth ulcers
Tongue (glossitis)
What is angular stomatitis and what can it be a sign of?
Inflamed red areas at the corners of the mouth.
Can be a sign of iron/B12 deficiency
What is oral candidiasis and what can it be a sign of?
White slough noted on oral mucous membranes
Can be a sign of iron deficiency or immunodeficiency
What can mouth ulcers it be a sign of, if found in a patient when doing an abdominal examination?
Crohn’s disease / coeliac disease
What is glossitis and what can it be a sign of?
Smooth swelling of the tongue with associated erythema
Can be a sign of iron, B12 or folate deficiency
What is the lymph node in the neck that you should check as part of an abdominal examination?
Virchow’s node – left supraclavicular fossa – suggestive of gastric malignancy
Name 3 signs you would look for on a patient’s chest as part of an abdominal examination.
Spider naevi
Gynaecomastia
Hair loss
What are spider naevi and what can they be a sign of? How many must there be to be considered a significant finding?
Central red spot with reddish extensions (>5 significant) – chronic liver disease
What is gynaecomastia and what can it be a sign of?
Overdevelopment of male mammary glands (pseudofeminisation)
Can be a sign of liver cirrhosis, digoxin toxicity or spironolactone toxicity.
What can hair loss it be a sign of, when found in a patient when doing an abdominal examination?
Malnourishment / iron deficiency anaemia
What might you look on closer inspection of the patient’s abdomen during an examination?
Scars - previous surgery, transplant, stoma
Visible masses - tumours, hernias
Visible pulsation of AAA
Distension
What are the five F’s denoting causes of distension that might be seen in an abdominal examination?
Fluid (ascites) Fat (obesity) Faeces (constipation) Flatus Fetus (pregnancy)
What is Cullen’s sign, something possibly seen during closer inspection of the abdomen during an examination?
Bruising surrounding umbilicus which signifies a retroperitoneal bleed. This is therefore a sign of pancreatitis/ruptured AAA.
What is Grey-Turner’s sign, something possibly seen during closer inspection of the abdomen during an examination?
Bruising in the flanks which signifies a retroperitoneal bleed. This is therefore a sign of pancreatitis/ruptured AAA.
Before palpating the abdomen, what must you do? How will this affect the manner in which you palpate the abdomen?
Ask about any painful sites. If there is a painful area, palpate it last.
How should you be positioned when palpating the abdomen, during the abdominal exam?
Crouch down and palpate the abdomen with your eye line at the same level as the patient’s. This will enable you to assess for tenderness.
How many segments of the abdomen should be individually palpated in the abdominal exam? Can you name them?
9
From right to left and top to bottom:
Right hypochondriac region
Epigastric region
Left hypochondriac region
Right lumbar region
Umbilical region
Left lumbar region
Right iliac region
Hypogastric region
Left iliac region
How many times do you palpate the abdomen in an abdominal examination?
Twice. Once lightly and then once deeper.
What are you looking for as you lightly palpate the abdomen during an abdominal examination?
Tenderness
Rebound tenderness
Guarding
Masses
What is rebound tenderness and what is it often a sign of?
Pain is worsened on releasing the pressure during palpation.
Often a sign of peritonitis.
Having palpated the 9 abdominal regions, what 4 parts of the abdomen should you palpate next in the abdominal exam?
Palpate liver
Palpate spleen
Ballot kidneys
Palpate for AAA - comment on whether it is expansile
What 4 areas do you percuss during the abdominal exam?
Percuss liver
Percuss spleen
Percuss bladder - remember to ask about going to loo recently
Percuss for shifting dullness
What do you auscultate for during the abdominal exam?
Bowel sounds - comment whether they are normal (gurgling), abnormal (e.g. “tinkling” - bowel obstruction) or absent (ileus / peritonitis)
Aortic bruits – auscultate just above the umbilicus – AAA
Renal bruits – auscultate just above the umbilicus, slightly lateral to the midline
What could you say that you would do at the end of an abdominal examination?
Look for ankle oedema Examine external orifices Examine external genitalia Take a stool/urine sample Perform a PR exam
