Abdominal Exam Flashcards
General inspection from the end of the bed of the patient
- comfortable and calm
- jaundice
- pallor
- muscle wasting/ cachexia
- confused
- obese
- abdominal distension
- dressings
- needle track marks (hepatitis/HIV)
- excoriation (pruritus in Cholestasis)
General inspection from around the bed
- vomit bowels
- feeding tubes
- stoma bags
- drains
- dialysis filter
What do you inspect nails for?
- clubbing (cirrhosis, IBD, coeliac)
- Leukonychia (hypoalbuminaemia in liver cirrhosis)
- koilonychia (IDA)
- Beau’s lubes (transverse ridges across nail)
- Cap refill time
What do you inspect the palms for?
- palmar erythema (hyperdynamic circulation due to inc oestrogen levels in liver disease and pregnancy)
- palmar crease pigmentation (Addison’s)
- Dupuytren’s contracture (familial, liver disease)
What do you inspect for in the arms?
- flapping tremor (hepatic encephalopathy, kidney failure)
- pulse (tachy and low volume of blood loss)
- take BP
- inspect arms for bruising (coagulation due to liver failure)
- tattoos (risk factor for infections)
- petechiae (low platelets in splenomegaly)
- AV fistula (dialysis)
- excoriation marks (skin becomes itchy in jaundice)
What do you look for in the eyes?
- conjunctival pallor
- sclerosing icterus (liver disease, biliary obstruction)
- periorbital xanthelasma (hyperlipidaemia in cholestasis)
- Kaiser-Fleischer rings (Wilson’s)
- corneal arcus
What do you look for in the mouth?
- Lips: angular stomatitis/chromosomes (iron/B12 def), localised pigmentation in Peru’s Jeghers syndrome
- gums: gingivitis, bleeding, hypertrophy, pigmentation, mouth ulcers (Chron’s and coeliac)
- tongue: glossitis (B12, folate, iron def), Oral candidiasis (iron def, immunodeficiency), leukoplakia (smoking, HIV)
- breath odour (ketotic in ketoacidosis, alcohol)
What do you look for in the neck?
- Virchow’s node of L: supraclavicular lymphadenopathy
- JVP: raised in portal HTN
What do you inspect the abdomen for?
- distension
- incisional hernias (ask pt to cough)
- scars/ striae (pregnancy, Cushing’s)
- spider naevi
- movement with respiration (absent in peritonitis)
- distended portal systemic anastomoses (portal HTN)
- scars (laparotomy)
- caput Medusa (engorged umbilical vein from portal HTN)
- stones (colostomy in RIF, ileostomy in LIF)
Which signs should you look for?
Cullen’s sign: bruising near umbilicus (retroperitoneal bleed from pancreatitis or ruptured AAA)
Grey-Turner’s sign: bruising in the flanks (retroperitoneal bleed from pancreatitis or ruptured AAA)
How do you do general palpate on of abdomen?
- ask if pt is in any pain
Superficial palpation: - start away from pain and kneel to pt level
- lightly palpate all 9 areas whilst watching pt face
- check for tenderness, guarding, rebound tenderness
Deep palpation: - masses, deep toner was
- Rosving’s sign (appendicitis), Murphy’s sigh (cholecystitis) morning
How do you palpate the liver?
- push in on inspiration
- move your L side of abdomen
- hepatomegaly: metastasis, cirrhosis, leukaemia, CCF
- tenderness in hepatitis
- pulsatile enlarged liver in tricuspid regurgitation
How do you palpate the spleen?
- push in on inspiration
- move across abdomen towards top right corner
- huge splenomegaly: lymphoma, CML, myelofibrosis, kala-azar
- moderate splenomegaly: portal HTN, storage disease e.g. Gauchers
- small splenomegaly: IE, typhoid
How do you palpate the kidney?
- L hand always underneath
- press firmly on abdomen and flick bottom hand up
- unilateral: carcinoma, hydronephrosis, cyst, hypertrophy
- bilateral: PCKD, bilateral hydronephrosis, amyloidosis
What else should you palpate for?
AAA
Press down in horizontal plane of umbilicus
Pulsatile not expansive
