Abdominal Examination Flashcards
What do you ask for in an abdominal history?
- Pain
- Nausea/Vomiting
- Diarrhoea/Constipation
- Dysphagia
- Jaundice
What do you ask about in pain?
- Site
- Onset
- Character
- Radiation
- Associated/Alleviating factors
- Timing
- Exacerbating factors
- Severity score /10
What do you ask about nausea/vomiting?
- onset
- relation to food
- quantity
- colour (food/bile/blood)
What do you ask about diarrhoea/constipation?
- onset/time course
- dietary changes
- associated features (fever, weight loss)
- stool colour (bloody/black)
- tenesmus
- steatorrhoea
- urgency/incontinence
- previous investigations
What do you ask about dysphagia?
- onset/time course
- solids/liquids
- level of obstruction
- associated features (heartburn, weight loss, vomiting)
- previous investigations
What do you ask about janudice?
- Onset/time course
- urine/stool colour
- alcohol use
- risk factors for hepatitis/HIV (e.g. IVDU)
- associated features (abdo pain, fever, weight loss, ascites, itchiness, fatigue)
What are 5 reasons of abdominal swelling?
- fat
- fluid
- fetus
- flatus
- faeces
Why is it important to take a detailed medication history?
as some medications may cause liver disease and some may predispose to gastritis/stomach ulcers
What is the position of the patient in an abdominal exam?
patient should be lying flat
What is the exposure of the patient in an abdominal exam?
the patient: ‘nipples to knees,’
What do you have to ask every patient before the examination?
Check if patient is in any pain
What do you look for at the end of bed inspection?
- Medications
- Obvious scars
- Pallor
- Abdominal distension
- Visible hernias
- Cachexia
- Stoma bags
- Drains
- Feeding tubes
- Mobility aids
- Fluid balance charts / obs charts
What are the hand signs to look for?
- Pallor
- Palmar erythema
- Dupuytren’s contracture
- Koilonychia
- Leukonychia
- Finger clubbing
- Asterixis
What are the face signs to look for?
- Conjunctival pallor
- Jaundice
- Corneal arcus
- Xanthelasma
What are the mouth signs to look for?
- Glossitis
- Aphthous ulceration
- palpate for lymphadenopathy, most notably Virchow’s node, which, if enlarged, could be a sign of gastric cancer
What are the chest signs to look for?
- gynaecomastia
- spider naevi
- hair loss
What are the abdomen signs to look for?
- Scars
- Hernias
- Abdominal distension
- Cullen’s sign
- Grey Turner’s sign
- Caput medusae
What do you palpate for in the abdominal exam?
- Light palpation
- Deep palpation
- Liver palpation
- Spleen palpation
- Balloting the kidneys
- Liver Percussion
- Spleen Percussion
- Palpation of aorta
What do you auscultate for in an abdominal exam?
- Bowel sounds (these may be normal, tinkling or absent)
- Aortic bruits
- Renal bruits
What do you examine the legs for in an abdominal exam?
- Rashes (erythema nodosum, pyoderma gangrenosum, vasculitic rashes)
- Peripheral oedema
What do you do with the patient at the end of the exam?
- thank the patient
- assist in covering them up
- . wash your hands
What would you tell the examiner to do to the complete the abdominal exam?
- Inspect the external genitalia
- Palpate the hernial orifices
- Perform a digital rectal examination
- Perform a urine dipstick / send off a stool sample
What conditions is younger patient more likely to have?
IBD
What are older patients more likely to have?
- chronic liver disease
2. malignancy
What can you see from end of bed?
- age
- confusion
- pain
- obvious scars
- abdominal distention
- pallor
- jaundice
- hyperpigmentation
- oedema
- cachexia
- hernias
What could confusion suggest in abdo?
end stage liver disease (hepatic encephalopathy)
What could abdominal distention suggest?
- ascites
- bowel obstruction
- organomegaly
What could a pale colour (anaemia) may mean?
- GI bleed
2. Malnutrition
What conditions may lead to jaundice?
- acute hep
- liver cirrhosis
- cholangitis
- haemochromatosis
What would oedma in a abdo sense suggest?
liver cirrhosis
What is hyperpigmentation associated with?
haematochromatosis
What is cachexia associated with?
- malignancy: pancreatic/bowel/stomach cancer
2. advanced liver failure
How can you get hernias to be more pronounced?
ask patient to cough
If you see a catheter what should you comment on?
volume/colour of urine
Where are colostomies usually located?
left iliac fossa
Where are ileostomies located?
right iliac fossa
If you see a surgical drain what should you comment on?
location of the drain and the type/volume of the contents within the drain (e.g. blood, chyle, pus)
If you see feeding tubes what should you comment on?
feeding tubes (e.g. nasogastric/nasojejunal) and whether the patient is currently being fed
What do inspect the palms for?
- pallor
- palmar eythema
- dupuyten’s contracture
What would pallor (anaemia) on palms suggest?
- malignancy
- GI bleeding
- malnutrition
What would palmar erythema suggest on the palms?
- chronic liver disease
2. normal in pregnancy
What are you looking at the nails for?
- koilonychia
2. leukonychia
What is koilonychia?
spoon-shaped nails, assoicated with iron deficiency anaemia
What could give koilonychia?
iron deficiency anaemia e.g. due to malabsorption in Crohn’s disease
What is leukonychia?
whitening of the nail bed associated with hypoalbuminaemia
When might there be leukonychia?
- end stage liver disease
2. protein-losing enteropathy
What are abdo reasons for finger clubbing?
- IBD
- Coeliac disease
- liver cirrhosis
- lymphoma of the GI tract
Why might there be asterixis (flapping tremor)
- hepatic encephalopathy (due to hyperammonaemia)
2. uraemia secondary to renal failure
What does cool hands suggest?
poor peripheral perfusion
Why may there be dupuytren’s contracture?
- genetics
- excessive alcohol use
3, increasing age - male gender
- diabetes
What do you look for on the arms?
- brusing
- excoriations
- needle track marks
What could bruising suggest?
underlying clotting abnormalities secondary to liver disease (e.g. cirrhosis)
Why do you look for excoriation?
scratch marks that may be caused by the patient trying to relieve pruritis (cholestasis can cause)
Why do you look for needle track marks?
increased risk of viral hep
