Abdominal examination Flashcards
What is the first part of any introduction to an examination?
Wash hands
Intro self
Pt details
Explain an abdo exam to a patient
I’ve been asked to examine your abdomen today, it’s going to involve me having a general inspection of your arms, face and chest before having a feel of your tummy in various areas, and listening with my stetho.
What else would you include in your intro?
Expose ok?
Chaperone?
Pain or discomfort?
What do you inspect in a abdo exam?
Bedside
General
Hands
Arms
Axillae
Face
Eyes
Mouth
Chest wall
Abdomen
When inspecting the bedside what are you looking for?
Feeding tubes
stoma bags
drains
When inspecting generally what are you looking for?
General appearance
body habitus
colour
What could the following indicate?
a) Obvious pallor
b) Jaundice
a) sig anaemia - ?GI bleed
b) Cirrhosis / hep / biliary issue
When inspecting the hands what are you looking for?
Clubbing;
Koilonychia (spooning of the nails);
Leukonychia (whitened nail bed);
Dupuytren’s contracture;
In a abdo exam what could clubbing indicate?
Hepatic cirrhosis.
Inflammatory bowel disease (ulcerative colitis/Crohn’s).
Coeliac disease.
In an abdo exam what could the following indicate?
a) Koilonychia
b) Leukonychia
c) Dupuytren’s contracture
a) Chronic iron deficiency
b) minor trauma / post chemo / hypoalbumaemia
c) ?alcoholism / liver failure
What are the different types of leukonychia?
What do they indicate?
Leukonychia partialis =
- white patches is normal in minor trauma but striae
affecting all nail beds can occur post chemotherapy.
Leukonychia totalis =
- hypoalbuminaemia caused by liver failure/nephrotic
syndrome/protein malabsorption/protein-losing
enteropathies.
What is Dupuytren’s contracture?
Fibrosis + shortening of the palmer aponeurosis
Before inspecting the arms in an abdo exam what else do you want to do?
Temp of hands + forearms
Radial pulse
Check for asterixis
When inspecting the arms in an abdo exam what are you looking for?
What may they suggest?
Bruising – abnormal coagulation (secondary to liver failure).
Petechiae – Low platelets (e.g. splenomegaly).
Scratch marks – Pruritus caused by cholestasis.
Track marks – IVDU (hepatitis).
When inspecting the axillae in an abdo exam what are you looking for?
What may they indicate?
Lymphadenopathy – Malignancy/infection.
Hair loss – Malnourishment/iron deficiency anaemia.
Acanthosis nigricans – Hyperpigmentation seen in GI
adenocarcinomas/obesity.
When inspecting the face in an abdo exam what are you looking for
Where else does it affect and cause?
Telangiectasia;
Affects the face, oral mucosa, GI tract, lungs, liver + brain
resulting in recurrent haemorrhage.
When inspecting the eyes in an abdo exam what are you looking for?
What does it indicate?
Xanthelasma (yellow raised lesions around the eyes);
- Hypercholesterolaemia.
Corneal arcus (yellowish/grey ring surrounding the iris);
- Hypercholesterolaemia.
Scleral jaundice;
- Haemolysis/hepatitis/cirrhosis/biliary obstruction.
Conjunctival pallor;
- Significant anaemia.
Kayser-Fleischer rings (brown rings that encircle the iris);
- Wilson’s disease due to copper deposition.
When inspecting the mouth in an abdo exam what are you looking for?
Pigmentation (freckles)
Angular stomatitis
Glossitis
Oral candidiasis (white slough on oral mucous membranes)
Dehydration
Halitosis (bad breath)
Dental caries
Ulcers
What do the following signs indicate?
a) Pigmentation (freckles);
b) Angular stomatitis;
c) Glossitis;
d) Oral candidiasis
e) Ulcers;
a) Peutz-Jegher syndrome, associated with small bowel
hamartomas.
b) Can be caused from vitamin B12, folate or iron
deficiency.
c) Painful = vitamin B12 or folate deficiency.
Painless = iron deficiency.
d) Iron deficiency/immunodeficiency.
e) Can be associated with vitamin B12/iron deficiency,
Crohn’s, Coeliac.
Before inspecting the chest and abdomen what else do you want to do?
JVP check
Palpate LN
When inspecting the chest wall in an abdo exam what are you looking for?
Spider naevi
Gynaecomastia
Hair loss;
What are the following?
a) Spider naevi
b) Gynaecomastia
a) Central red spot with red extensions
b) Male breast development
What number of spider naevi are considered significant?
> 5
What are the following associated / indications of?
a) spider naevi
b) gynaecomastia
c) hair loss
a) Associated with chronic liver disease.
b) Can be due to increased circulating oestrogens in liver
failure, digoxin or spironolactone.
c) Malnourishment/iron deficiency anaemia.