Abdominal Examination

Question 1

What may you look for on general inspection for the abdomen?

Answer 1

NG tubes, cardiac monitors etc. general

Abdominal distention, scars etc.

Question 2

What signs may appears on a patient’s nails?

Answer 2

Leukonychia - low albumin
Koilonychia - spoon-shaped nails from iron deficiency4
Clubbing

Question 3

What other signs may be present in a patient’s arms or hands?

Answer 3

Palmar erythema - liver disease
Dupuytren’s contracture - hereditary or ETOH 9ring finger contracted)

Bruising - abnormal clotting
Excoriations - obstructive jaundice
AV fistula for dialysis can be palpated and auscultated
Signs of IVDU (IV drug use)

Question 4

What signs may you seen in the face?

Answer 4

Eyes
Conjunctival pallor - anaemia
Yellowing of sclera - jaundice
Kayser-fleischer rings - deposition in Wilson's disease
Mouth
Ulcers - crohns
Candida - immunosuppression
Mucus membranes for hydration

Question 5

What signs may be present on the chest?

Answer 5

Spider naevi - blanching lesions that fill from centre, up to 5 is normal in women, 3 in men but can be found in liver disease
Gynaecomastia in liver disease

Question 6

What signs may be present in the neck and chest?

Answer 6

Acanthosis nigricans - darkened axilla in diabetes and gastric cancer
Lymphadenopathy - enlarged left supraclavicular associated with gastric cancer

Question 7

What position is key to remember?

Answer 7

Relax arms by side and uncross legs

Question 8

What is caput medusa?

Answer 8

Dilated veins visible in liver disease, caused by portal hypertension

Question 9

What is the divarication of rectus?

Answer 9

Muscles of the abdominal wall are apart but the linea alba is together, so causes a prominence

Question 10

On coughing, what could you notice?

Answer 10

A hernia or if it elicits pain it could be a sign of peritonitis

Question 11

What are some special tests on palpation?

Answer 11

Peritonism -
Rebound tenderness (press slowly and lift off fast) and percussion tenderness
Cholecystitis -
Murphy’s sign, palpate RUQ during insp, limited by pain, however not on LUQ
Appendicitis -
Pain at McBurney’s point
Rovsing’s - pain in RIF when palpating LIF
Psoas test, active hip flexion against resistance

Question 12

What skin lesions might you see?

Answer 12

Erythema nodosum or pyroderma gangrenosum in IBD

Vasculitic rashes

Question 13

What might kolinychia suggest?(spoon shaped nails)

Answer 13

Anaemia

Question 14

What is leukonychia?

Answer 14

Whitening of the nail due to hyperalbuminaemia. Could be in chronic liver disease etc.

Question 15

What is duputreyen’s contracture?

Answer 15

Thickening of tendons in palm. Sign of alcohol related (men, old, diabetes) liver disease, may be genetic.

Question 16

What is palmar erythema linked to?

Answer 16

Oestrogen deficiency, pregnancy normally, liver disease.

Question 17

How do we identify an AV fistula?

Answer 17

Thrill palpated or auscultate for bruit at wrist or antecubital fossa. Created for haemodialysis.

Question 18

What can cause darkened axillae (acanthsosis nigricans)?

Answer 18

GI malignancy, diabetes

Question 19

What is virchow’s node?

Answer 19

Enlarged node in left supraclavicular fossa and can be first sign of gastric cancer.

Question 20

What might angular stomatitis be a sign of? (reddening around lips)

Answer 20

Iron deficiency

Question 21

What might glossitis be a sign of?

Answer 21

B12, folate, iron deficiency