Abdominal Examination

Question 1

What are you looking for at the end of the bed?

Answer 1

Monitoring - fluid balance
Treatments - O2, IV, NG tube, surgical drain, catheter
Paraphernalia - food and drink, NBM sign, vomit bowl, stoma kit, cigarettes, Creon (pancreatic insufficiency)
Patient - alert, behaviour (writhing pain = colicky, very still = peritonism), body habitus, colour (anaemia, jaundice, hyperpigmentation in haemachromatosis and Addison’s)

Question 2

Nails

Answer 2

• Clubbing (Crohn’s, UC, Coeliac, Cirrhosis, Cancer)
• Leukonychia (pale nails due to low albumin - nephrosis, cirrhosis, coeliac)
• Koilonychia (spoon shaped nails due to Fe deficiency anaemia)

Question 3

Hands

Answer 3

• palmar erythema - chronic liver disease - redness of heel of palm
• dupytrens contracture - excessive alcohol use
• tar stains

Question 4

Arms

Answer 4

• excoriations - pruitis secondary to hyperbilirubinaemia
• tattoos and IV drug use marks
• bruising - chronic liver disease clotting issues
• liver flap

Question 5

Eyes

Answer 5

• Kaiser Fletcher rings (with slit lamp)
• corneal arcus
• xanthelasma
• conjunctival pallor
• scleral ictus

Question 6

Mouth

Answer 6

• apthous ulcers (Crohn’s or B12/folate/Fe deficiency)
• angular stomatitis - B12/folate/Fe deficiency
• hydration status
• glossitis - B12/folate/Fe deficiency
• oral candidiasis - immunosuppression

Question 7

Anything else on the face?

Answer 7

- breath 
   o pear drops (DKA) 
   o alcohol 
   o foetor hepaticus - liver failure
- bilateral parotid gland swelling - chronic alcohol abuse, recurrent vomiting e.g. bulimia

Question 8

Neck

Answer 8

• lymphadenopathy - esp Virchow’s node

Question 9

Chest

Answer 9

• gynaecomastia and lack of hair due to excess oestrogen (cirrhosis)
• spider naevi - liver cirrhosis

Question 10

Screening tests

Answer 10

• lie flat
• head to chest - divertication of the rectus, paraumbilical hernia, incisional hernia
• cough and feel hernial orifices
• deep breath - peritonitis

Question 11

Inspect

Answer 11

• distension (fat, fluid, flatus, foetus, faeces, fucking big tumour)
• scars
• PEG tube
• stomas
• striae (Cushing’s, pregnancy)
• Caput medusae - engorged paraumbilical veins (portal hypertension, liver cirrhosis)
• Grey-Turner and Cullen’s sign - bruising around flanks and umbilical area = pancreatitis
• AAA pulsations

Question 12

Palpate

Answer 12

• 9 areas, shallow then seep
• liver + poss Murphy’s sign
• spleen
• kidneys
• AAA

Question 13

Percuss

Answer 13

• liver
• spleen
• shifting dullness
• bladder

Question 14

Auscultate

Answer 14

• bowel sounds x 4

- AAA and renal arteries - bruits

Question 15

Legs

Answer 15

• peripheral oedema

- erythema nodosum (painful nodules associated with Crohn’s)

Question 16

To complete the abdominal examination

Answer 16

HIDE in the PUB

• hernial orifices
• inguinal lymph nodes
• DRE
• external genitalia
• pregnancy test
• urine dip
• basic obs