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MBBS 3: Physical Examinations > Abdominal Examination > Flashcards

Abdominal Examination Flashcards

1
Q

The GIT system comprises of?

A
  1. alimentary tract,
  2. liver,
  3. biliary system,
  4. pancreas
  5. spleen
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2
Q

The alimentary tract comprises of?

A

Extends from the mouth to the anus and includes
the
1. oesophagus,
2. stomach,
3. small intestine or small bowel (duodenum, jejunum and
ileum),
4. colon (large intestine or large bowel)
5. rectum.

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3
Q

Positioning of a patient?

A
  1. Examine the patient in good light and warm surroundings,
  2. Supine with the head resting on only one or two pillows to relax the
    abdominal wall muscles.
  3. Use extra pillows to support a patient with kyphosis or
    breathlessness.
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4
Q

Examination sequence?

A
  1. Introduction and explanation!
  2. Inspection
  3. Palpation
  4. Percussion
  5. Auscultation
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5
Q

Inspection?

A
  1. Step back!
    * Look around the patient
    * Drains / medication / fluids / vomit bowl / tubes
  2. Expose – ‘knee to nipple’?
  3. Look at the patient
    - Note general appearance and level of Discomfort
  4. Ask them to point to site of pain
    - Note the position assumed by the patient when in pain
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6
Q

What are you looking for upon general inspection of patient?

A
  1. distension,
  2. yellow
  3. muscle wasting
  4. scratch marks
  5. spider naevi
  6. purpura,
  7. oedema
  8. tattoos
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7
Q

What is spider naevi?

A

dilated small blood vessels of skin (telangiectases) that consist of a centerally dilated arteriole from which numerous small vessels radiate resembling a spiders legs
- sign of hepatocellular failure

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8
Q

Clinical association of spider naevi?

A
  1. cirrhosis of liver - especially alcoholics
  2. viral hepatitis (transient)
  3. 3rd trimester of pregnancy
  4. sometimes in thyrotoxicosis
  5. oestrogen therapy
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9
Q

What is purpura?

A

a rash of purple spots due to small blood vessels leaking blood into the skin, joints, intestines or organs

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10
Q

Inspection of hands?

A
  1. finger clubbing
  2. leuconychia
  3. koilonychia
  4. palmar erythema
  5. Dupyterns contracture
  6. spider naevus
  7. pupurae
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11
Q

Finger clubbing?

A

abnormal rounded shape of the nail bed
- causes by chronic low blood oxygen levels

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12
Q

Finger clubbing test?

A

Schamroth window test
- if 2 opposing fingers are held back to back against each other a diamond shaped space should normally appear between the nail beds and the nails of the 2 fingers
> in clubbing this space is missing

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13
Q

GI causes of finger clubbing?

A
  1. Cirrhosis
  2. Ulcerative Colitis
  3. Crohn’s disease
  4. Coeliac disease
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14
Q

CVS causes of clubbing?

A
  1. infective endocarditis
  2. cyanotic congenital heart disease
    - result in a low blood oxygen level
  3. atrial myxoma
    - tumour in the atria of the heart
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15
Q

Respiratory causes of clubbing?

A
  1. lung cancer
    - except small cell
  2. chronic suppurative lung disease
    - cystic fibrosis, bronchiectasis, lung abscess, empyema
  3. pulmonary fibrosis
  4. NOT COPD
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16
Q

Other causes of clubbing?

A
  1. thyrotoxicosis (thyroid acropathy)
  2. hereditary
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17
Q

Other causes of clubbing?

A
  1. thyrotoxicosis (thyroid acropathy)
  2. hereditary
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18
Q

What is leuconychia?

A

white discolouration appearing on nails

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19
Q

Causes of leuconychia?

A
  1. nail bed injury
  2. mineral deficiency
    - zinc, calcium
  3. iron deficiency anemia
  4. chronic renal disease
  5. hypoalbuminemia
  6. liver cirrhosis
20
Q

Koilonychia?

A

soft nails that look scooped out

21
Q

Causes of koilonychia?

A

iron deficiency anemia
1. malnutrition
2. worms
3. celiac disease
4. GI blood loss
5. malignancy

22
Q

Palmar erythema?

A

skin condition that makes the palms of your hands turn red

23
Q

Causes of palmar erythema?

A
24
Q

Dupytrens contracture?

A

gradual thickening and tightening of tissue under the skin in the hand
- most often affects the 4th (ring) and 5th (little) fingers

25
Q

Causes of Dupytrens contracture?

A
26
Q

Inspection of eyes?

A
  1. Look DOWN for jaundice:
    - Inspect sclera
  2. Look UP for anaemia:
    - Inspect lower eyelid conjunctiva
27
Q

What to look for in inspecting the mouth?

A

Mouth / breath / lips / tongue / teeth / gums
1. Stomatitis
2. glossitis
3. candidias
4. ulcers
5. pigmentation
(Peutz- Jegers Syndrome - v. rare)
6. telangiectasia,
7. dentition
8. gingivitis
9. odours
10. KS lesions

28
Q

Glossitis?

A

inflammation of the tongue
- change in tongue texture and colour
- swelling and tenderness
- loss of papillae

29
Q

Causes of glossitis?

A
  1. benign conditions
  2. nutriotional deficiency
    - iron deficiency anemia
    - B12 deficiency
  3. infections
    - oral herpes
    - candida
  4. allergies
  5. autoimmune conditions
    - celiac disease
    - Sjorgen syndrome
  6. mouth injuries
30
Q

What is oral candidiasis?

A

infection in which the fungus Candida albicans accumulates in the mouth

31
Q

What is angular stomatitis?

A

inflammation and small cracks in one or both corners of the mouth

32
Q

What are karposi sarcoma lesions?

A

kaposi sarcoma causes lesions to grow in in skin, lymph nodes and internal organs amd mucous membranes lining the mouth nose and throat
- affects people that are immunocompromised
e.g. HIV/AIDS

33
Q

Cervical lymph node exam?

A
  1. May indicate local disease
  2. May indicate more distant disease:
    - Tumours of the upper gastrointestinal tract may metastasise to the lower part of the left posterior cervical
    triangle
    - Nodes in supraclavicular fossa
34
Q

Chest inspection?

A
  1. Gynaecomastia and loss of axillary hair in men may be evidence of chronic liver disease
  2. breast atrophy in women
35
Q

Abdominal inspection?

A
  1. Expose abdomen
    - Lie flat with one pillow.
  2. Movement, distension, scars, herniae, masses, striae (similar to
    stretch marks), dilated veins
  3. Distension
    - Fat, Fluid, Faeces, Flatus, Foetus
36
Q

Abdominal surgical scars?

A
  1. Mercedes benz
  2. right sub costal (Kochers)
  3. right paramedian
  4. appendicentomy
  5. suprapubic
  6. inguinal
  7. upper/lower midline
37
Q

Abdominal palpation?

A

Start away from any area of pain -watch the patient’s face!!
- Superficial, then deep palpation:
1. Position yourself at patient’s level by sitting, kneeling or squating
2. Feel with whole hand
3. Flex at MCP joint

38
Q

What are we palpating for?

A
  1. Tenderness
    - including guarding or re-bound tenderness)
  2. masses
  3. organomegaly (liver, spleen, kidneys) 4. abdominal aorta
39
Q

Inspection of the liver?

A
  1. Liver moves with respiration
  2. Begin in right iliac fossa
  3. Ask the patient to breathe
    in and out deeply
  4. Palpate upwards to right
    costal margin
  5. Feel for liver edge
40
Q

Inspection of hepatomegaly?

A
  • Smooth / nodular / generalised or focal
    enlargement
  • Associated symptoms (e.g. jaundice)
41
Q

Causes of hepatomegaly?

A
  1. Hepatitis
  2. Alcoholic liver disease
  3. Right heart failure
  4. Fatty infiltration
  5. Biliary tract obstruction
  6. Malignancy (metastatic / primary) etc
42
Q

Inspection of the spleen?

A
  1. Spleen moves with respiration
  2. Begin in right iliac fossa
  3. Ask the patient to breathe in and out deeply
  4. Palpate upwards to left hypochondrium
  5. Feel for edge of an enlarged spleen
43
Q

Causes of splenomegaly?

A
  1. Haematological - Haemolytic anaemias / Leukaemias /
    Polycythaemia rubra vera / Lymphoma / essential
    thrombocythaemia / myelofibrosis
  2. Infective (e.g. infectious mononucleosis, infective
    endocarditis, TB, malaria)
  3. Congestive splenomegaly - Liver cirrhosis / portal or splenic
    vein obstruction / Portal hypertension
  4. Abscess / metastases / tumours
    Note: May be up to 3 times normal size before being palpable
44
Q

Technique for renal enlargement?

A

2 handed technique to ballot the kidneys

45
Q

Causes of renal palpation?

A
  1. Hydronephrosis
  2. Polycystic kidney disease
  3. Renal cell carcinoma
  4. In children, nephroblastoma
    (Wilm’s tumour)
  5. Solitary cysts
46
Q

What is percussion?

A

The percussing finger is the
middle finger of your right
hand.
* Fluid, relaxed flexion of right
wrist joint
* Volume is increased by
pushing harder on the
abdomen / chest with the
percussed middle finger of
your left hand
* Differentiates air filled spaces
(resonant) from fluid or solid
filled (dull)

MBBS 3: Physical Examinations (19 decks)

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