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Phase 1b - Clinical Practical Assessment (CPA) > Abdominal Examination > Flashcards

Abdominal Examination Flashcards

1
Q

What exposure is required for an abdominal examination?

A

Exposure from xiphisternum to the pubic symphysis

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2
Q

What position is required for an abdominal examination?

A

Supine position with the no upper body elevation

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3
Q

What lines divides the abdomen into 4 quadrants?

A
  • Transumbilical plane (Horizontal)
  • Median plane (Vertical)
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4
Q

The abdomen can be divided into 4 quadrants. Name them starting from the right superolateral point and going clockwise.

A
  • Right upper quadrant
  • Left upper quadrant
  • Left lower quadrant
  • Right lower quadrant
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5
Q

What lines divide the abdomen into 9 regions?

A
  • Left midclavicular line (Vertical)
  • Right midclavicular line (Vertical)
  • Subcostal plane (Horizontal)
  • Intertubercular plane (Horizontal)
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6
Q

The abdomen can be divided into 9 regions. Name them starting from the right superolateral point and going S - shaped.

A
  • Right hypochondrium
  • Epigastric
  • Left hypochondrium
  • Left lumbar
  • Umbilical
  • Right lumbar
  • Right inguinal
  • Pubic
  • Left inguinal
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7
Q

What are the 4 main areas of abdominal general inspection?

A
  • Shape & symmetry
  • Skin abnormalities
  • Surgical scars (indicating prior abdominal pathology)
  • Masses
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8
Q

What does swollen / distended abdomen suggest?

A

Ascites

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9
Q

What does abdominal asymmetry suggest?

A

Abdominal mass

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10
Q

What do enlarged veins on anterior umbilical wall suggest?

A

Portal hypertension

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11
Q

What does everted umbilicus suggest?

A

Umbilical hernia

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12
Q

What does sunken umbilicus suggest?

A

Obesity

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13
Q

In what order is the abdomen palpitated?

A
  • Light palpation (S shape)
  • Deep palpation (S shape)
  • Liver palpation (Red arrow)
  • Spleen palpation (Green arrow)
  • Bimanual palpation of the kidney, balloting of the kidneys
  • Palpation of the AA (Purple star)
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14
Q

How is light and deep palpitation performed?

A

S-shaped

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15
Q

How is liver palitation performed?

A

Right inferolaterally to right superiorlaterally (Red arrow)

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16
Q

How is spleen palitation performed?

A

Right inferolaterally to left superiorlaterally (Green arrow)

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17
Q

How is bimanual palpation of the kidney performed?

A

Balloting of the kidneys

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18
Q

How is palpitation of the abdominal aorta performed?

A

Firm pressure in umbilical region (Purple star)

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19
Q

What are the surface markings of the liver & the gallbladder?

A
  1. Right 5th rib at midclavicular line
  2. Lower end of sternum
  3. Left 5th intercostal space at midclavicular line
  4. Costal margin at right midaxillary line
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20
Q

What are the surface markings of the spleen?

A
  • Lateral border of erector spinae muscles
  • Midaxillary line
  • 9th intercostal space
  • 11th intercostal space
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21
Q

What are the surface markings of the kidneys & ureters?

A
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22
Q

What are the surface markings of the abdominal aorta (AA)?

A
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23
Q

In what order is the abdomen percussed?

A
  • Abdominal palpation (S shape)
  • Liver palpation (Red arrow)
  • Spleen palpation (Green arrow)
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24
Q

How is abdominal percussion performed?

A

S-shaped

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25
Q

How is liver percussion performed?

A

Right inferolaterally to right superolaterally (Red arrow)

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26
Q

How is spleen percussion performed?

A

Right inferolaterally to left superolaterally (Green arrow)

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27
Q

How is percussion of shifting dullness performed?

A
28
Q

What is the clinical significance of abdominal hyperresonance?

A

Air in the abdomen

29
Q

What is the clinical significance of abdominal hyporesonance?

A

Fluid

30
Q

What is the clinical significance of shifting abdominal hyporesonance?

A

Tests for ascites

31
Q

How is auscultation of the abdomen performed?

A
  • Only listen in 2 regions
  • Listen for 30s
32
Q

What is the clinical significance of abdominal auscultation?

A
  • Bowel sounds must not be present for 3-4 minutes in order to conclude that they are missing
    • Indicate constipation
33
Q

What does abdominal pain on movement generally indicate?

A

Musculoskeletal pain

34
Q

What does abdominal colicky pain generally indicate?

A

Indicates obstruction

35
Q

What does abdominal constant pain generally indicate?

A

Indicates inflammation

36
Q

What does colicky pain on the right hypochondriac region indicate?

A
  • Cholelithiasis
  • Choledocholithiasis
37
Q

What is cholelithiasis? Where does it radiate?

A
  • Cholelithiasis is the presence of one or more calculi (gallstones) in the gallbladder
  • Radiates through to the back & the right
38
Q

What is choledocholithiasis? Where does it radiate?

A
  • Choledocholithiasis is the presence of at least one gallstone in the common bile duct
  • Radiates through to the back & the right
39
Q

What does colicky pain on right lumbar region & right iliac region indicate?

A

Urinary tract calculi

40
Q

What is urinary tract calculi? Where does it radiate?

A
  • Urinary tract calculi are hard masses that form in the urinary tract and may cause pain, bleeding, or an infection or block of the flow of urine
  • Radiates to the loin & to the groin
41
Q

What does colicky pain on umbilical region indicate?

A

Small Bowel Obstruction / Large Bowel Obstruction (SBO/LBO)

42
Q

Where does Small Bowel Obstruction / Large Bowel Obstruction (SBO/LBO) radiate?

A

Does not normally radiate

43
Q

What does constant pain on the right hypochondriac region indicate?

A
  • Cholecystitis
  • Hepatitis
  • Cholangitis
44
Q

What is cholecystitis? Where does it radiate?

A
  • Cholecystitis is a redness & swelling (inflammation) of the gallbladder
  • Radiates through to the back & the right
45
Q

What is hepatitis? Where does it radiate?

A
  • Hepatitis means inflammation of the liver
  • Does not normally radiate
46
Q

What is cholangitis? Where does it radiate?

A
  • Cholangitis is an inflammation of the bile duct system
  • Radiates through to the back & the right
47
Q

What does constant pain on the right lumbar region indicate?

A

Nephritis

48
Q

What is nephritis? Where does it radiate?

A
  • Nephritis is a condition in which the nephrons, the functional units of the kidneys, become inflammed
  • Radiates to the loin & to the groin
49
Q

What does constant pain on the right iliac region indicate?

A

Appendicitis

50
Q

What is appendicitis? Where does it radiate?

A
  • Appendicitis is an inflammation of the appendix
  • Does not normally radiate
51
Q

What does constant pain on the epigastric region indicate?

A
  • Pancreatitis
  • Gastritis
  • Chron’s disease
52
Q

What is pancreatitis? Where does it radiate?

A
  • Pancreatitis is inflammation of the pancreas
  • Radiates straight through to the back
53
Q

What is gastritis? Where does it radate?

A
  • Gastritis is inflammation of the lining of the stomach
  • Radiates straight through to the back
54
Q

What is Chron’s disease? Where does it radiate?

A
  • Chron’s disease is a type of inflammatory bowel disease (IBD)
  • Does not normally radiate
55
Q

What does constant pain on the hypogastric region indicate?

A

Cystitis

56
Q

What is cystitis? Where does it radiate?

A
  • Cystitis is the inflammation of the bladder
  • Does not normally radiate
57
Q

What does constant pain on the left iliac region indicate?

A
  • Diverticulitis
  • Ulcerative Colitis (UC)
58
Q

What is diverticulitis? Where does it radiate?

A
  • Diverticulitis is the infection or inflammation of pouches that can form in your intestines
  • Does not normally radiate
59
Q

What is Ulcerative Colitis (UC)? Where does it radiate?

A
  • Ulcerative Colitis (UC) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract
  • Does not normally radiate
60
Q

How does one differentiate between MRI and CT scans?

A

Bones on CT scans appears white, while in the MRI appears black

61
Q

How does one differentiate between small and large bowel obstruction on X Ray?

A
  • Remember the 3,6,9 rule of the AXR
    • Small bowel diameter <3cm
    • Colon <6cm
    • Caecum <9cm
62
Q

What are the key presentations of acute appendicitis (6)?

A
  • Tenderness at McBurney’s point
  • Rovsing sign
  • Psoas Sign
  • Obturator sign
  • Blumberg’s sign
  • Triad of anorexia, nausea and vomiting
63
Q

What are the key presentations of unruptured abdominal aortic aneurysm (3)?

A
  • Often asymptomatic
  • Bruits (abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction or a localized high rate of blood flow through an unobstructed artery) on auscultation
  • Pulsatile & laterally expansile pulse
64
Q

What are the key presentations of ruptured abdominal aortic aneurysm (2)?

A
  • Signs of shock (tachycardia, hypotension, loss of consciousness)
  • May see Cullen’s or Grey Turner’s sign
65
Q

What are the key presentations of bowel obstruction (6)? What are the distinct presentations of SBO (2)? What are the distinct presentations of LBO (2)?

A
  • Abdominal distention
  • Bloating
  • Nausea
  • Vomiting
  • Constipation
  • Colicky abdominal pain
  • SBO:
    • Bilious vomiting early sign
    • Abdominal distention less prevalent
  • LBO:
    • Faeculent vomiting late sign
    • Abdominal distention has high prevalence
66
Q

What are the key presentations of peritonitis (7)?

A
  • Diffuse abdominal pain
  • Tenderness
  • Guarding
  • Rigidity
  • Rebound tenderness
  • Patient lying still
  • Systemic symptoms: fever, tachycardia, nausea and vomiting

Phase 1b - Clinical Practical Assessment (CPA) (5 decks)

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