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Year 3 CCA > Abdominal Examination > Flashcards

Abdominal Examination Flashcards

1
Q

What level of exposure is adequate for an abdominal examination?

A

Xiphisternum to pubic symphysis

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2
Q

What are you looking for in the surrounding area?

A
  1. Drips
  2. Oxygen
  3. Drains/ stomas
  4. Vomit bowel
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3
Q

What are you looking for on general inspection of the patient?

A
  1. Body habitus
  2. Well/ unwell
  3. Pain
  4. Fever
  5. Jaundice
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4
Q

What are you looking for when inspecting the nails?

A
  1. Clubbing
  2. Leuconychia
  3. Koilonychia
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5
Q

What is clubbing and what might it indicate (abdo related)?

A

Clubbing is the loss of the nail bed angle.

May be seen in:

  1. IBD
  2. Cirrhosis
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6
Q

What is leuconychia and what might it indicate?

A

Leuconychia is whitening of the nail beds due to low albumin.

May be seen in:

  1. Malnutrition
  2. Malabsorption
  3. Chronic liver disease
  4. Nephrotic syndrome
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7
Q

What is koilonychia and what might it indicate?

A

Koilonychia is the spooining of the nails.

May be seen in:
1. Iron deficiency (congenital or chronic)

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8
Q

What are you looking for when inspecting the hands?

A
  1. Xanthomata
  2. Dupuytren’s contracture
  3. Palmar erythema
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9
Q

What is xanthomata and what might it indicate?

A

Xanthomata are raised yellow lesions on tendons.

May be seen in:
1. Hyperlipidaemia through primary biliary cirrhosis

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10
Q

What is Dupuytren’s contracture and what might it indicate?

A

Dupuytren’s contracture is the thickening and contracture of palmar fascia.

May be seen in:

  1. Alcoholic liver disease
  2. Manual work
  3. Familial
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11
Q

What is palmar erythema and what might it indicate?

A

Palmar erythema is the blotchy reddening of the palms (due to increase in circulating oestrogen).

May be seen in:

  1. Chronic liver disease
  2. Pregnancy
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12
Q

What are you looking for when inspecting the wrists and arms?

A
  1. Pulse (being aware of AV fistula)
  2. Flapping tremor
  3. Brusing
  4. Scratch marks
  5. Track marks and tattoos
  6. Dermatitis Herpeteformis
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13
Q

How do you test for flapping tremor? What might it indicate?

A

Arms straight out in front, wrists cocked back, fingers spread for >15 secs. Look for jerky, irregular flexion/ extension (may be subtle).

May indicate:
1. Encephalopathy due to liver failure

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14
Q

What might bruising indicate?

A

Chronic liver disease (as may affect clotting)

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15
Q

What might scratch marks indicate?

A

Raised urea

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16
Q

Why is it important to check for track marks and tattoos?

A

Hepatitis risk

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17
Q

What are you looking for on inspection of the eyes?

A
  1. Yellowing of sclera
  2. Conjunctival pallor
  3. Corneal arcus
  4. Xanthelasma
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18
Q

What does yellowing of the sclera indicate?

A

Jaundice

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19
Q

What does conjunctival pallor indicate?

A

Anaemia

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20
Q

What does corneal arcus and xanthelasma indicate?

A

Hyperlipidaemia

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21
Q

What are you looking for on inspection of the mouth?

A
  1. Angular stomatitis and glossitis
  2. Ulcers (e.g. aphthous)
  3. Foector hepaticus
22
Q

What is angular stomatitis?

A

Reddening and inflammation at the sides of the mouth.

23
Q

What is glossitis?

A

Erythematous swelling of the tongue.

24
Q

What do angular stomatitis and glossitis indicate?

A

Iron, folate and B12 deficiencies.

25
What might mouth ulcers indicate?
1. Coeliac 2. IBD 3. Iron deficiency
26
What is foector hepaticus and what might it indicate?
Foectus hepaticus is a musty, sweet breath (due to inability to process sulphur). May be seen in: 1. Liver failure
27
What are you looking for inspection of the chest?
1. Virchow's node 2. Gynaecomastia 3. >5 spider naevia
28
What is Virchow's node and what might it indicate?
Left supraclavicular swollen node. May be seen in: 1. Gastric cancer
29
What might gynaecomastia indicate?
1. Alcoholic liver disease | 2. Drugs (DISCO: digoxin, isoniazid, spironolactone, cimetidine, oestrogens)
30
What might >5 spider naevi indicate?
1. Chronic liver disease | 2. Any other cause of excess oestrogen
31
What are you looking for on inspection of the abdomen?
1. Distension 2. Everted umbilicus (with distension) 3. Distended abdominal veins 4. Hernias 5. Scars and stomas
32
What are the 6 things that can cause distention?
1. Fat 2. Fluid 3. Flatus 4. Faeces 5. Foetus 6. F***ing big mass
33
What might an everted umbilicus with distension indicate?
? Ascites
34
What do distended abdominal veins indicate?
Portal hypertension
35
What is the term to describe pain as you release?
Rebound tenderness
36
What is the term to describe involuntary tension of abdominal muscles?
Guarding
37
If you feel an abdominal mass, what should you include in your description of it?
1. Location 2. Size 3. Shape 4. Surface 5. Consistency 6. Mobility 7. Movement (with respiration) 8. Tenderness 9. Pulsatile
38
What are causes of hepatomegaly?
1. Alcoholic liver disease 2. Malignancy (particularly metastases) 3. Congestive cardiac failure 4. Hepatitis (viral, drug-induced) 5. Haemochromatosis 6. Non-alcoholic fatty liver disease
39
What is Dermatitis Herpeteformis and what is it associated with? How is it treated?
Blistering, very itchy skin condition affecting the extensor surfaces. Associated with Coeliac Disease. Treated with dapsone and a gluten free diet.
40
What are causes of splenomegaly?
1. Chronic myeloid leukaemia 2. Mononuceleosis infection 3. Portal hypertension 4. Haemolytic anaemias 5. Sickle Cell Anaemia
41
What are signs of inflammation bowel disease?
1. Aphthous mouth ulcers 2. Erythema nodosum 3. Pyoderma gangrenosum 4. Anal fissures 5. Surgical scars 6. Ocular complications (e.g. iritis, uveitis, episcleritis) 7. Anaemia signs 8. Nutrition status
42
What is erythema nodosum?
Tender, red bumps, usually found symmetrically on the shins.
43
What is pyoderma gangrenosum?
Large, painful sores develop on skin (most often legs).
44
What are classical stigmata of chronic liver disease?
1. Spider naevi 2. Palmar erythema 3. Jaundice 4. Hair loss 5. Leuconychia 6. Asterixis 7. Ascites
45
What might a positive Murphy's sign indicate?
Cholecystitis
46
In a situation of a suspected abdominal aortic aneurysm, which side will the pulsatile mass enlarge towards?
Enlarges to left side.
47
A mass in the suprapubic area that is dull is most likely what?
Bladder
48
A mass in the suprapubic area that is resonant is most likely what?
Distended bowel.
49
What do tinkling/ high pitched bowel sounds indicate?
Partial or total obstruction.
50
What do loud low pitched (borborygmus) bowel sounds indicate?
Diarrhoeal or abnormal peristalsis.
51
What do absent bowel sounds indicate and how long must you listen before declaring absent?
Must listen for 2 minutes. Absent sounds may indicate paralytic ileus or peritonitis.

Year 3 CCA (3 decks)

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