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Clinical Paediatric Examination > Abdominal Examination > Flashcards

Abdominal Examination Flashcards

1
Q

what level of exposure of the child should you have of the child during the examination

A

nipple to knee (but in an older child this is not necessary)

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2
Q

what are you looking for on general inspection?

A

are they well or unwell- GCS
increased facial or body hair (ciclosporin side effect)
skin rashes (dermatitis herpetiformis, perioral freckling (Peutz Jeghers), telangiectasia (Osler Weber Rendu)
Pigmentation- cafe au last with NF1 also associated with GI stroll tumours
dysmorphic features- course features of mucopolysaccharidoses
nutritional status- thriving or not thriving
nutritional support (NG tube, TPN, gastrotomy tube (peg), button
peritoneal dialysis catheter
urinary catheter (spina bifida)
older child in nappies
race ( afro Caribbean sickle cell, asian thalessaemia, and Chinese hepatitis B)

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3
Q

what are you looking at on the hands: finger clubbing

A

cystic fibrosis, chrons disease and ulcerative colitis, liver disease

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4
Q

Other than clubbing what else are you looking for on hand examination

A

anemia (nailbed pallor and palmer crease)
koilonychia (due to iron deficiency look also for smooth tongue and angular stomatitis)
leuconychia (cirrhosis)
xanthoma (hypercholeserolaemia- tendon deposits, tuberous xanthomas at elbow)
palmer erythema (chronic liver disease)
flapping tremor

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5
Q

What are you looking at on inspection of the face?

A

jaundice (looking specifically at the sclera)
cyanosis (hepatopulmonary syndrome) or facial plethora (chronic liver disease)
spider naevi or telangiectasia (Osler Weber Rendu syndrome or ataxic telangiectasia)

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6
Q

what are you looking at when examining the mouth

A

pigmentation (Peutz Jeghers Syndrome)
ulceration (aphthous ulcers- chrons, ulcerative colitis, coeliac, behcets disease)
dental caries
gum hypertrophy (myeloid leucemia and drugs like ciclosporin and phenytoin)
Macroglossia

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7
Q

what are the causes of macroglossia

A
  1. hypothyroidism
  2. Beckwith- Wiedemann Syndrome
  3. Mucopolysaccharidoses
  4. Pompe Glycogen Storage Disease
  5. Amyloid
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8
Q

on general inspection of the abdomen what are you looking for

A

distension
skin
scars
striae
stomas
genital area
hernia or scrotal swellings

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9
Q

what are the 5 Fs of distension

A

fat
faeces
flatus (air swallowing, malabsorption- coeliac disease, intestinal obstruction)
fluid (ascites: nephrotic syndrome, chronic liver disease)
Fetus

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10
Q

what scars are you looking for?

A

renal angle scars
liver biopsy scars
laparoscopic surgery

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11
Q

what is William Harvey’s method?

A

press on the veins with two fingers
pull fingers apart
lift one finger does vein fill?

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12
Q

what does William Harvey’s method help with?

A

it assesses the blood flow from the blood in the veins

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13
Q

how to tell if the striae is a caput medusae

A

veins drain away from the umbilicus due to portal vein obstruction. Then look for other signs of liver disease (liver failure is a specific end stage problem.

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14
Q
A
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15
Q

how to tell if the striae is from superior vena cava obstruction

A

blood flows inferiorly in the superficial abdominal veins (look for this in children with central lines- rare complication)

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16
Q

how do you know if it is inferior vena cava obstruction

A

blood flows superiorly in the superficial abdominal veins (obstruction is unlikely in exams)

17
Q

what are you looking for when looking at a stoma?

A

ileostomy vs colostomy
mucous fistula
caecostomy tube for integrate enemas in some children with chronic constipation

18
Q

what are you looking for on the genital exam

A

ambiguous, undescended testis

19
Q

what are the different types of hernia

A

umbilical: common in healthy afro Caribbeans below the age of 5, Down syndrome, hypothyroidism, and mucopolysaccaridoses
inguinal hernia
hydrocele

19
Q

what are you looking at on examination of the skin

A

scratch marks
bruising
rash
pigmentation
nappy area

20
Q

what causes scratch marks on the skin

A

obstructive jaundice
lichenification
excoriation
erythema
visible pruritis

21
Q

what causes bruising in patients

A

liver dysfunction
haematological disease

22
Q

what kind of rash are you looking for

A

dermatitis herpetiformis in coeliac disease

23
Q

what causes depigmentation

A

vitiligo

24
Q

what causes hyperpigmentation

A

cafe au lait patches
incontinentia pigmentosa (stage 3 cutaneous lesions associated with dystrophic changes of the hair, nails and teeth

25
Q

what causes hypopigmentation

A

incontinentia pigmentosa (stage 5)
- permanent linear hypopigmented streaks particularly on the legs
associated with alopecia

26
Q

on palpation what areas are important

A

neck (feeling for lymphadenopathy)
gentle and deep palpation of the abdomen
feel for the liver, spleen, kidneys

27
Q

how do you palpate

A

you lie your hand flat and feel by flexing at the metacarphalangeal joints

28
Q

how do you feel for the liver

A

flex the fingers at the metacarpophalengeal joint using the forefingers parallel to the costal margin. begin in the right iliac fossa and work up towards the costal margin. children frequency have a palpable liver edge up t o 2 cm.

29
Q

how to further assess hepatomegaly

A

position: measure the liver edge below the costal margin in the midclavicular line with a tape measure
texture: smooth or nodule, firm or soft
tenderness
pulsatile (hepatic AV malformation)
expansile (tricuspid incompetence)
percussion don’t forget to define the upper border of the liver to exclude hyperinflation of the liver edge

30
Q

how do you feel for the spleen

A

palpate from the right iliac fossa with the left hand splitting the lower edge of the rib age posteriorly
if there is difficulty lie the child on her right side and palpate with the child taking big breaths
the spleen tip may be palpable in normal neonates
measure the sleep from the costal margin in the midclavicular line
percuss the border of the spleen

31
Q

how do you palpate the kidneys

A

bimanual palpation
push up with the left hand in the renal angle and feel the kidney anteriorly with the right hand.
ballot the kidneys between the hands

32
Q

if a mass is found how do you describe it

A

site size shape
consistency
mobility
whether tender
whether pulsatile
percussion
does it alter after bowel or bladder movement

33
Q

what are you percussing for

A

organomegaly, mass, fluid

34
Q

when to percuss for ascites

A

if there is hepatomegaly
if any signs of liver disease
if the abdomen appears distended
if there is oedema elsewhere

35
Q

when would you listen for renal bruits

A

if the child has neurofibromatosis or is hypertensive

36
Q

how do you determine if the scrotal swelling is a hernia vs hydrocele?

A

hernia transmits cough impulse, the testis can be palpated separately. A hydrocele I can get above it, and it transilluminates.

37
Q
A

Clinical Paediatric Examination (11 decks)

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