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Z Year3 Clinical Examinations > Abdominal Examination > Flashcards

Abdominal Examination Flashcards

1
Q

What do you ask for in an abdominal history?

A
  1. Pain
  2. Nausea/Vomiting
  3. Diarrhoea/Constipation
  4. Dysphagia
  5. Jaundice
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2
Q

What do you ask about in pain?

A
  1. Site
  2. Onset
  3. Character
  4. Radiation
  5. Associated/Alleviating factors
  6. Timing
  7. Exacerbating factors
  8. Severity score /10
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3
Q

What do you ask about nausea/vomiting?

A
  1. onset
  2. relation to food
  3. quantity
  4. colour (food/bile/blood)
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4
Q

What do you ask about diarrhoea/constipation?

A
  1. onset/time course
  2. dietary changes
  3. associated features (fever, weight loss)
  4. stool colour (bloody/black)
  5. tenesmus
  6. steatorrhoea
  7. urgency/incontinence
  8. previous investigations
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5
Q

What do you ask about dysphagia?

A
  1. onset/time course
  2. solids/liquids
  3. level of obstruction
  4. associated features (heartburn, weight loss, vomiting)
  5. previous investigations
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6
Q

What do you ask about janudice?

A
  1. Onset/time course
  2. urine/stool colour
  3. alcohol use
  4. risk factors for hepatitis/HIV (e.g. IVDU)
  5. associated features (abdo pain, fever, weight loss, ascites, itchiness, fatigue)
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7
Q

What are 5 reasons of abdominal swelling?

A
  1. fat
  2. fluid
  3. fetus
  4. flatus
  5. faeces
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8
Q

Why is it important to take a detailed medication history?

A

as some medications may cause liver disease and some may predispose to gastritis/stomach ulcers

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9
Q

What is the position of the patient in an abdominal exam?

A

patient should be lying flat

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10
Q

What is the exposure of the patient in an abdominal exam?

A

the patient: ‘nipples to knees,’

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11
Q

What do you have to ask every patient before the examination?

A

Check if patient is in any pain

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12
Q

What do you look for at the end of bed inspection?

A
  1. Medications
  2. Obvious scars
  3. Pallor
  4. Abdominal distension
  5. Visible hernias
  6. Cachexia
  7. Stoma bags
  8. Drains
  9. Feeding tubes
  10. Mobility aids
  11. Fluid balance charts / obs charts
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13
Q

What are the hand signs to look for?

A
  1. Pallor
  2. Palmar erythema
  3. Dupuytren’s contracture
  4. Koilonychia
  5. Leukonychia
  6. Finger clubbing
  7. Asterixis
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14
Q

What are the face signs to look for?

A
  1. Conjunctival pallor
  2. Jaundice
  3. Corneal arcus
  4. Xanthelasma
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15
Q

What are the mouth signs to look for?

A
  1. Glossitis
  2. Aphthous ulceration
  3. palpate for lymphadenopathy, most notably Virchow’s node, which, if enlarged, could be a sign of gastric cancer
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16
Q

What are the chest signs to look for?

A
  1. gynaecomastia
  2. spider naevi
  3. hair loss
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17
Q

What are the abdomen signs to look for?

A
  1. Scars
  2. Hernias
  3. Abdominal distension
  4. Cullen’s sign
  5. Grey Turner’s sign
  6. Caput medusae
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18
Q

What do you palpate for in the abdominal exam?

A
  1. Light palpation
  2. Deep palpation
  3. Liver palpation
  4. Spleen palpation
  5. Balloting the kidneys
  6. Liver Percussion
  7. Spleen Percussion
  8. Palpation of aorta
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19
Q

What do you auscultate for in an abdominal exam?

A
  1. Bowel sounds (these may be normal, tinkling or absent)
  2. Aortic bruits
  3. Renal bruits
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20
Q

What do you examine the legs for in an abdominal exam?

A
  1. Rashes (erythema nodosum, pyoderma gangrenosum, vasculitic rashes)
  2. Peripheral oedema
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21
Q

What do you do with the patient at the end of the exam?

A
  1. thank the patient
  2. assist in covering them up
  3. . wash your hands
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22
Q

What would you tell the examiner to do to the complete the abdominal exam?

A
  1. Inspect the external genitalia
  2. Palpate the hernial orifices
  3. Perform a digital rectal examination
  4. Perform a urine dipstick / send off a stool sample
23
Q

What conditions is younger patient more likely to have?

A

IBD

24
Q

What are older patients more likely to have?

A
  1. chronic liver disease

2. malignancy

25
Q

What can you see from end of bed?

A
  1. age
  2. confusion
  3. pain
  4. obvious scars
  5. abdominal distention
  6. pallor
  7. jaundice
  8. hyperpigmentation
  9. oedema
  10. cachexia
  11. hernias
26
Q

What could confusion suggest in abdo?

A

end stage liver disease (hepatic encephalopathy)

27
Q

What could abdominal distention suggest?

A
  1. ascites
  2. bowel obstruction
  3. organomegaly
28
Q

What could a pale colour (anaemia) may mean?

A
  1. GI bleed

2. Malnutrition

29
Q

What conditions may lead to jaundice?

A
  1. acute hep
  2. liver cirrhosis
  3. cholangitis
  4. haemochromatosis
30
Q

What would oedma in a abdo sense suggest?

A

liver cirrhosis

31
Q

What is hyperpigmentation associated with?

A

haematochromatosis

32
Q

What is cachexia associated with?

A
  1. malignancy: pancreatic/bowel/stomach cancer

2. advanced liver failure

33
Q

How can you get hernias to be more pronounced?

A

ask patient to cough

34
Q

If you see a catheter what should you comment on?

A

volume/colour of urine

35
Q

Where are colostomies usually located?

A

left iliac fossa

36
Q

Where are ileostomies located?

A

right iliac fossa

37
Q

If you see a surgical drain what should you comment on?

A

location of the drain and the type/volume of the contents within the drain (e.g. blood, chyle, pus)

38
Q

If you see feeding tubes what should you comment on?

A

feeding tubes (e.g. nasogastric/nasojejunal) and whether the patient is currently being fed

39
Q

What do inspect the palms for?

A
  1. pallor
  2. palmar eythema
  3. dupuyten’s contracture
40
Q

What would pallor (anaemia) on palms suggest?

A
  1. malignancy
  2. GI bleeding
  3. malnutrition
41
Q

What would palmar erythema suggest on the palms?

A
  1. chronic liver disease

2. normal in pregnancy

42
Q

What are you looking at the nails for?

A
  1. koilonychia

2. leukonychia

43
Q

What is koilonychia?

A

spoon-shaped nails, assoicated with iron deficiency anaemia

44
Q

What could give koilonychia?

A

iron deficiency anaemia e.g. due to malabsorption in Crohn’s disease

45
Q

What is leukonychia?

A

whitening of the nail bed associated with hypoalbuminaemia

46
Q

When might there be leukonychia?

A
  1. end stage liver disease

2. protein-losing enteropathy

47
Q

What are abdo reasons for finger clubbing?

A
  1. IBD
  2. Coeliac disease
  3. liver cirrhosis
  4. lymphoma of the GI tract
48
Q

Why might there be asterixis (flapping tremor)

A
  1. hepatic encephalopathy (due to hyperammonaemia)

2. uraemia secondary to renal failure

49
Q

What does cool hands suggest?

A

poor peripheral perfusion

50
Q

Why may there be dupuytren’s contracture?

A
  1. genetics
  2. excessive alcohol use
    3, increasing age
  3. male gender
  4. diabetes
51
Q

What do you look for on the arms?

A
  1. brusing
  2. excoriations
  3. needle track marks
52
Q

What could bruising suggest?

A

underlying clotting abnormalities secondary to liver disease (e.g. cirrhosis)

53
Q

Why do you look for excoriation?

A

scratch marks that may be caused by the patient trying to relieve pruritis (cholestasis can cause)

54
Q

Why do you look for needle track marks?

A

increased risk of viral hep

Z Year3 Clinical Examinations (33 decks)

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