Abdominal Examination

Question 1

What are the first steps?

Answer 1

Introduction
Ask name and DOB
Consent
Ask if they are in any pain

Question 2

What do you look for on general inspection?

Answer 2

Ascites
Scars
Pallor
Jandice
Hyperpigmentation
Oedema
Cachexia
Hernias

Question 3

What equipment do you looks for on general inspection?

Answer 3

Stoma
Feeding tubes
ECG leads
Mobility aids
Fluids

Question 4

What’s the first thing you inspect ?

Answer 4

Hands

Question 5

What are you assessing the hands for?

Answer 5

Nails - Koilonychia ( spoon nails)
Leukonychia ( whitening )

Palms - Pallor, Palmar , Dupuytren’s contracture

Finger clubbing

Asterixis

Question 6

What does Palmor Erythema indicate?

Answer 6

Chronic liver disease

Question 7

What does Koilonychia indicate?

Answer 7

Iron deficiency anemia

Question 8

What does Leukonychia indicate?

Answer 8

Hypoalbuminaemia

Question 9

What does finger clubbing indicate ?

Answer 9

IBD
Coeliac
Liver cirrhosis

Question 10

What does asterixis indicate?

Answer 10

Hepatic encephalopathy

Question 11

What else do you assess the hands for?

Answer 11

Symmetrical temperature
Radial pulse

Question 12

What does Dupuytren’s contracture indicate

Answer 12

Excessive alcohol consumption
Diabetes

Question 13

What do you inspect the face for?

Answer 13

Anaemia
Jaundice

Question 14

What do you inspect the mouth for?

Answer 14

Mouth ulcers
Angular stomatitis
Glossitis
Oral candidiasis

Question 15

What do you inspect the eyes for ?

Answer 15

Conjunctival pallor
Jaundice
Corneal Arcus
Xanthelasma
Kayser-Fleischer rings

Question 16

What does Corneal Arcus suggest?

Answer 16

Hypercholesterolaemia

Question 17

What does Xanthelasma suggest?

Answer 17

Hypercholesterolaemia

Question 18

What does Kayser-Fleischer rings suggest?

Answer 18

Abnormal copper processing of liver

Question 19

What lymph nodes do you palpate?

Answer 19

Supraclavicular
Submandibular
Submental
Anterior and Posterior Cervical
Occipital
Virchows!!!

Question 20

What is Virchow’s Node?

Answer 20

Left Supraclavicular lymph node

Question 21

How do you inspect the abdomen ?

Answer 21

Ask patient to lie flat
Hands by sides

Question 22

What are you inspecting the abdomen for?

Answer 22

Scars
Striae
Masses
Distension
Gynaecomastia
Spider Naevi
Stomas
Pulsation
Cullen’s Sign
Grey Turners Sign

Question 23

What are the 9 different areas of the stomach ?

Answer 23

Right hyperchondrium
Epigastrium
Left hyperchondrium
Right flank
Umbilical region
Left flank
Right iliac fossa
Suprapunic region
Left iliac fossa

Question 24

How do you palpate the abdomen?

Answer 24

Ask if patient is in any pain

Lightly palpate 9 areas
Deeply palpate 9 areas

Question 25

How do you palpate liver?

Answer 25

Right iliac fossa
Ask them to deep breathe

Question 26

How do you palpate the spleen ?

Answer 26

Right iliac fossa to the suprapunic region,

Question 27

How do you ballot the kidneys ?

Answer 27

Press on Right and Left Iliac Fossa’s and feel for kidneys on sides of stomach

Question 28

What else do you palpate?

Answer 28

Palpate the aorta
Middle around epigastric

Question 29

What is Cullen’s Sign?

Answer 29

Bruising of umbilicus region ( late pancreatitis signs)

Question 30

What is Grey-Turner’s sign?

Answer 30

Bruising of the flanks ( late haemorrhaging pancreatitis )

Question 31

Which parts of abdomen do you percuss?

Answer 31

Liver
Spleen
Shifting dullness ( if relevant)
Fluid thrill ( if relevant )

Question 32

What do you percuss?

Answer 32

Borders of the liver
Borders of the spleen
Shifting Dullness ( if Ascites is suspected )

Question 33

What do you auscultate?

Answer 33

Bowel sounds ( lower left + right )
Aortic bruit ( middle central )
Renal arteries ( lateral to aortic )

Question 34

What would you do to complete the examination

Answer 34

Check hernial orifices
External genitalia
Digital Rectal Examination