Abdominal Examination Flashcards
What can be looked for in abdominal examination during general inspection?
Patient: well/unwell, pain/discomfort, jaundice, pallor, muscle wasting, cachexia
around bed: vomit bowels, IV infusions, nutrition, catheter
what can be seen in the hands during examination in a abdominal exam
flapping tremor
nails: clubbing, leukonychia, koilonychia
palms: palmar erythema, Dupuytren’s contracture, fingertip capillary glucose marks
what may cause clubbing?
IBD
cirrhosis
coeliac disease
what may cause leukonychia
hypoalbuminemia in liver cirrhosis/ enteropathy
what may cause kolionychia?
iron deficiency
what may cause palmar erythema
hyperdynamic circulation due to increased oestrogen levels in liver disease/pregnancy
what may cause duppuytren’s contracture?
can be related to alcoholism or liver disease
why might a patient have fingertip capillary glucose monitoring marks?
diabetes
how do you demonstrate a flapping tremor?
patient hold arms out straight with wrists cocked back
what may cause a flapping tremor?
hepatic encephalopathy
what should be checked in a face examination in an abdominal exam?
eyes
mouth
what may be seen in eyes in a face exam in an abdominal exam?
sclera for jaundice
conjunctival pallor
periorbital xanthelasma
when might a patient have scleral jaundice?
liver disease
what is the cause of conjunctival pallor?
anaemia- GI bleed, malabsorption etc
what is periorbital xanthelasma caused by?
hyperlipidaemia in cholestasis
what should be checked for in the mouth in abdominal examinations?
glossitis/stomatitis
aphthous ulcers
breath odour
what may cause glossitis/ stomatitis?
iron/ vit B12 deficiency
what may cause aphthous ulcers?
IBD
what may cause a feculent breath odour?
obstruction
what may cause a fruity breath odour?
ketoacidosis
what may cause a fetor hepaticus/sweet breath odour?
portal hypertension
what are the odours that should be checked for in the mouth?
feculent
fruity
sweet/ fetor hepaticus
alcohol odour
what lymph node is most important to check?
left supraclavicular fossa- virchow’s node
what is virchow’s node a sign of?
gastric malignancy
when are spide naevi signigicant?
>5
when might skin lesions be seen on a back?
immunosuppresison
what should be check on chest inspection?
spider naevi
gynacomastia
loss of axillary hair loss
what may cause spider naevi, gynecomastia and loss of peripheral hair loss?
all caused by increased oestrogen
liver disease or pregnancy
what are the causes of abdominal distention?
Fat
fluid
flatus
fetus
faeces
what may cause Striae?
pregnancy
cushing’s disease
what causes caput medusae?
portal hypertension
what should be checked on abdominal examination?
scars
distention
spider naevi
hernias
movement with respiration
obvious pulsations
distended abdominal wall veins
stomas
when is abdominal wall movement on respiration absent?
peritonitis
what should be asked before starting palpation?
any pain- start away from painful areas
what is the order of palpation of abdomen?
superficial
deep
liver
spleen
kidney
aorta
when is rovsing’s sign seen?
appendicitis
when in murphy’s sign seen?
cholecystitis
what may hepatomegaly be caused by?
metastasis/ hepatocellular carcinoma
heppatitis
RVF
leukaemia/lymphoma
fatty liver
alcoholic liver disease
what may cause splenomegaly?
lymphoma/ leukaemia
myelofibrosis
myeloproliferative disorders
portal hypertension
extravascular haemolysis
malaria/ EBV
what is the difference between spleen and kidney palpation?
cannot get above spleen
spleen notched
spleen not ballotable
spleen moves down on inspiration
what does a pulsatile, expansile mass on abdominal aorta palpation suggest?
AAA
