Abdominal Examination Flashcards
Why do you ask the patient in an abdominal examination to lift the head of the bed?
Difficult for patients with peritonitis
What is Koilonychia?
What does it indicate?
Spoon shaped nailes
Seen in Iron-deficiency anaemia
What is Leukonychia?
What does it indicate?
Whitening of Nailbed
Indication of Hypoalbuminaemia
Which GI conditions might cause Clubbing?
- IBD
- Coeliac Disease
- Liver cirrhosis
- Lymphoma of the GI tract
What is A)Dupuytren’s Contracture?
What is it associated with?
: thickening of the palmar fascia, eventually resulting in contracture deformities of the fingers and thumb
Associated with -Alcohol related chronic liver disease
What is Palmar Erythema?
What is it associated with?
Associated with high Oestrogen
Chronic liver disease
•Normal finding in pregnancy
What are possible causes for Asterixis?
- REsp Failure: CO2 retention
- Kidney failure : Uraemia
- Liver Failure: Hepatic encelopathy
What is an AV fistula? What does it indicate?
Ateriovenous fistula = connection between artery and vein
- created in patients on haemodialysis
What is Acanthosis Nigricans?
What are possible causes?
darkening (hyperpigmentation) and thickening (hyperkeratosis) of the axillary skin
Can be
- benign
- Due to Insulin resistance
- GI malignancy
What are Excoriation marks?
What might they indicate in an Abdnominal Examination
Eg. scratchmarks on arms
due to itching/pruritis – underlying cholestasis – obstructive/cholestatic jaundice - deposition of bile salts in skin leading to itching
What are possible GI reasons for Hairloss (e.g. at chest, arms)?
- Liver disease –> High Oestrogen
- Iron Deficiency Anaemia, Malnutrition
Why do you check the JVP in an abdominlal exam?
To check the fluid status
- e.g. overload in liver failure
What is an important Lymphadenopathy in an GI examination?
Virchow’s node: Lymphnode at left supraclavicular fossa
- Troisier’s sign if palpable
- Might indicate Metastatic intraabdominal malignancy (mostly. gastric cancer)
How do you call the sign if Virchows node can be palpated?
Troisier’s sign
(lymphnode at left suproclavicular fossa)
What are possible GI reasons for Glossitis?
B12, Folate deficiency
What are possible GI reasons for Angular Stomatitis?
Unspecific, might indicate IBD
Which GI conditionn is Pigmentation of the Mouth associated with?
GI polyps and malignancies
Which GI conditions are Aphthous ulcers in the mouth associated with?
Typically benign, can be associated with iron,/folate/B12 deficiency or Crohn’s Disease.
What are Spider Naevi an indication of ?
High Oestrogen
- Normal in Pregnancy
- Might be sing of Liver cirrhosis
What are possible reasons for Abdominal Distensions?
F at
F luid
F atulence
F aecies
F Foetus
F ulminal Mass
What might Abdominal pulsations indicate?
- Aortic Aneurism
- Normal pulsation in lean people
- Tranmission due to pancreatic/gastric tumor
What is Cullens sign?
Bruising around the umbillicus due to haemorrhagic pancreatitis
What si Grey-Turners sign?
Sign of haemorrhagic pancreatitis
Bleeding into the falciform ligament
What is Rebound tenderness a sign of?
This is a non-specific, unreliable clinical sign that can, in some cases, be associated with peritonitis (e.g. appendicitis
Which characteristics of an abdominal mass should you describe?
- location
- size
- consistency
- mobility
- pulsatility
In Hepatomegaly: What would smooth vs irregular surface/edges indicate?
- Carcinoma/ Metastisice
- cirrhosis
- cysts
- (and many more)
What are causes for an tender liver at abdominal palpation?
- hepatitis
- rapid liver enlargement (right heart failure, Budd-Chiari)
- hepatocellular carcinoma (HCC)
- hepatic abscess
- biliary obstruction/ cholangitis
What are possible reasons for a pulsatile liver?
- tricuspid regurgitation
- hepatocellular carcinoma
- vascular abnormalities
- aortic transmission
What are possible causes for hepatomegaly?
Many
- alcoholic liver disease
- liver cirrhosis
- hepatitis - viral, autoimmune
- malignancy
- Right heart failure
- Haematological disorders (lymphoma, leukemia etc.)
What are possible reasons for Splenomegaly?
Many
- Haematological disorders
- Portal Hypertension
- Certain Infections
- Rheumatological conditions
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How would you percuss shifting dullness in an abdominal examination?
What does it indicate?
An indication of Ascitis
Percuss: umbilical region –> left or right flank
Resonant changes to dull
Roll onto their side (30 seconds)
Repeat percussion over same area
If ascites present: note will change from dull to resonant
What abnormal findings do you listen for in auscultation of Bowel Sounds?
Auscultate at 2 Positions
- High pitched bowel sounds
- Bowel obstructions
- Abscent
- Ileus
- Peritonitis
- Bruits
- AAA
- RAS
- Hepatic neoplasm and alcoholic hepatitis
