Abdominal examination

Question 1

What would you look at in the hands in an abdominal exam?

Answer 1

1. Tendon xanthomata
2. Dupuytren’s contracture
3. Palmar erythema

Question 2

What causes Dupuytren’s contracture?

Answer 2

Chronic liver disease
Diabetes 
Heavy labour 
Phenytoin 
Trauma
Familial

Question 3

What causes palmar erythema?

Answer 3

Chronic liver disease
Pregnancy
Hyperthyroidism
Rheumatoid Arthritis

Question 4

What would you look at in the nails in an abdominal exam?

Answer 4

Finger clubbing
Leuconychia
Koilonychia

Question 5

What is leuconychia?

Answer 5

White spots on the nails

Question 6

What causes leuconychia?

Answer 6

Hypoalbuminaemia due to e.g. chronic liver disease

Question 7

What causes koilonychia?

Answer 7

Iron-Deficient anaemia (e.g. GI bleeds)

Question 8

What causes clubbing due to GI causes?

Answer 8

IBD
Cirrhosis
Lymphoma
Coeliac disease

Question 9

What would you look at in the wrist in an abdominal exam?

Answer 9

Flapping tremor

Radial pulse rate

Question 10

What causes a flapping tremor?

Answer 10

Hepatic failure

Respiratory or renal failure

Question 11

What would you look at in the arms in an abdominal exam?

Answer 11

Bruising (CLD)

IV drug use marks (hepatitis B and C)

Question 12

What would you look at in the face in an abdominal exam?

Answer 12

Cushingoid (alcohol)
Parotid enlargement (alcohol)

Question 13

What is part of a Cushingoid appearance?

Answer 13

Moon face
Plethora
Acne
Hirsute

Question 14

What would you look at in the eyes in an abdominal exam?

Answer 14

Scleral icterus
Corneal arcus and xanthelasma
Episcleritis and conjunctivitis
Conjunctival pallor

Question 15

What causes scleral icterus?

Answer 15

Serum bilirubin > 35 micromol/L

Question 16

What are episcleritis and conjunctivitis a sign of?

Answer 16

IBD

Question 17

What would you look at in the mouth in an abdominal exam?

Answer 17

Angular stomatitis and glossitis
Oral candidiasis
Apthous ulcers
Fetor hepaticus

Question 18

What are angular stomatitis and glossitis a sign of?

Answer 18

Iron, folate or B12 deficiency

Question 19

What is oral candiasis a sign of?

Answer 19

Immunodeficiency

Question 20

What are apthous ulcers a sign of?

Answer 20

IBD (mainly Crohn’s)

Question 21

What is fetor hepaticus a sign of?

Answer 21

Hepatic failure (mercaptan accumulation)

Question 22

What would you look at in the neck in an abdominal exam?

Answer 22

Lymph nodes

Question 23

What lymph node is significant in an abdominal examination?

Answer 23

Left supraclavicular (Virchow’s)

Gastric cancer

Question 24

What would you look at in the chest and back in an abdominal exam?

Answer 24

Gynaecomastia
Loss of secondary sexual hair
Spider naevi

Question 25

What is gynaecomastia a sign of?

Answer 25

CLD Drugs Testicular failure

Question 26

What is loss of secondary sexual hair a sign of?

Answer 26

CLD

Question 27

What are spider naevi a sign of?

Answer 27

Chronic liver disease

Question 28

How would you position the patient the examine the abdomen?

Answer 28

Flat Then inspect, palpate, percuss and auscultate

Question 29

What would you inspect for in an abdominal exam?

Answer 29

Abdominal distension: fat, fluid, faces, flatus, fetes, fecking big mass Caput medusa: portal hypertension Scars

Question 30

What scars could you see in an abdominal examination?

Answer 30

1. Kocher's (subcostal): open cholecystectomy 2. Right paramedic laparotomy (pancreatic transplant) 3. Midline laparotomy 4. Nephrectomy 5. Gridiron (appendicetomy) 6. Laparoscopic 7. Left paramedian - anterior resection of rectum 8. Pfannenstiel/transverse suprapubic: TAH, Caesarian section

Question 31

What can cause ascites in CLD?

Answer 31

1. Portal hypertension 2. Hypoalbuminaemia 3. Salt and water retention secondary to RAAS activation

Question 32

What are the causes of hepatomegaly (think 2 Is, 2 Bs, 2 Cs)

Answer 32

Infection Infiltration Blood-related Biliary Cancer Congestion

Question 33

What are the infective causes of hepatomegaly?

Answer 33

Viral hepatitis EBV Malaria Hepatic abscess

Question 34

What are the infiltrative causes of hepatomegaly?

Answer 34

sarcoid Amyloid Fatty liver Haemochromatosis

Question 35

What are the blood-related causes of hepatomegaly?

Answer 35

Lymphoma Leukaemia Myeloproliferative disorders Haemolytic anaemias

Question 36

What are the biliary causes of hepatomegaly?

Answer 36

Primary biliary cirrhosis | Primary sclerosis cholangitis

Question 37

What are the cancer causes of hepatomegaly?

Answer 37

Primary hepatocellular carcinoma | Metastatic deposits

Question 38

What are the congestive causes of hepatomegaly?

Answer 38

Right heart failure Tricuspid regurgitation Budd-Chiari syndrome

Question 39

How would you palpate in an abdominal examination?

Answer 39

1. General palpation: tenderness, guarding, masses (WATCH THE FACE). Light then deep palpation, tell me if there is any pain 2. Liver: RIF to right costal margin, feel for liver edge during inspiration. Percuss outer and lower hepatic borders 3. Spleen: RIF - left costal margin. Feel during inspiration 4. Ballot kidneys 5. AAA

Question 40

What causes splenomegaly?

Answer 40

``` Malaria Myelofibrosis CML Infective endocarditis RA ```

Question 41

What would you percuss in an abdominal exam?

Answer 41

Shifting dullness Usually 1.5< L of fluid if shifting dullness positive

Question 42

What would you auscultate in an abdominal exam?

Answer 42

1. Bowel sounds (just below umbilicus) 2. Renal bruits (superior and lateral to umbilicus) 3. Liver bruit IF liver edge felt

Question 43

How would you describe bowel sounds?

Answer 43

Active, sluggish, tinkling, obstructive

Question 44

What causes liver bruits?

Answer 44

Hepatocellular carcinoma AV malformation TIPSS

Question 45

What would you feel for in the legs during an abdominal examination?

Answer 45

Peripheral oedema Erythema nodosum Pyoderma gangrenosum

Question 46

What is erythema nodosum a sign of?

Answer 46

IBD

Question 47

What is pyoderma gangrenosum a sign of?

Answer 47

IBD | RA

Question 48

What other examinations could you suggest after an abdominal examination?

Answer 48

Groin Genitalia DRE