Abdominal Examination 2 Flashcards
What do you look for on the axillae?
- acanthosis nigricans
2. hair loss
What is acanthosis nigricans?
darkening (hyperpigmentation) and thickening (hyperkeratosis) of the axillary skin
What is acanthosis nigricans associated with?
- benign
- insulin resistance
- GI malignancy (stomach cancer)
What is loss of axillary hair associated with?
- iron deficiency anaemia
2. malnutrition
What do you look for in the eyes?
- conjunctival pallor
- jaundice
- corneal arcus
- xanthelasma
- Kayser-Fleischer rings
- Perilimbal injection
What could conjunctival pallor suggest?
underlying anaemia
What would corneal arcus in under 50years suggest?
hypercholesterolaemia
What is xanthelasma associated with?
hypercholesterolaemia
What are kayser-fleischer rings?
dark rings that encircle the iris
What are kayser-fleischer rings assoicated with?
Wilson’s diases (abnormal copper processing by the liver, resulting in accumulation and deposition in various tissues (including the liver causing cirrhosis)
What is perilimbal injection?
inflammation of the area of conjunctiva adjacent to the iris
What is perilimbal injection a sign of?
sign of anterior uveitis, which can be associated with inflammatory bowel disease
What do you look for in the mouth of a patient?
- angular stomatitis
- glossitis
- oral candidasis
- aphthous ulceration
- hyperpigmented macules
What can cause angular stomatitis?
iron deficiency (e.g. gastrointestinal malignancy, malabsorption)
What is glossitis?
smooth erythematous enlargement of the tongue
What is glossitis associated with?
iron, B12 and folate deficiency (e.g. malabsorption secondary to inflammatory bowel disease).
What is oral candidasis associated with?
immunosuppression
What is aphthous ulceration?
round or oval ulcers occurring on the mucous membranes inside the mouth
What is aphthous ulceration associated with?
- benign (stress, mechanical trauma)
- iron, B12, folate deficiency
- Crohn’s disease
What are hyperpigmented macules a sign of?
athognomonic for Peutz-Jeghers syndrome
What is Peutz-Jeghers sydnromes?
autosomal dominant genetic disorder that results in the development of polyps in the gastrointestinal tract
When is Virchow’s node felt?
metastatic intrabdominal malignancy (gastric cancer)
What do you look for on the patient’s chest?
- spider naevi
- gynaecomstia
- hair loss
What are spider naevi?
skin lesions that have a central red papule with fine red lines extending radially caused by increased levels of circulating oestrogen
What pathology is spider naevi found in?
- liver cirrhosis (more than 5)
2. Normal if pregnancy or on combined pull
What is gynaecosmastia?
enlargement of male breast tissue caused by increased levels of circulating oestrogen
What can cause gynaecosmastia?
- liver cirrhosis
- digoxin
- spironolactone
What can cause hair loss on abdomen?
- increased level of circulating oestrogen
2. general malnourishment
What are you looking for on abdominal inspection?
- scars
- abdominal distension
- caput medusa
- striae (strech marks)
- hernias
- Cullen’s sign
- Grey-Turner’s sign
What can abdominal distension be caused by?
- fat
- fluid
- flatus
- faeces
- fetus
- fucking big mass
What is caput medusae?
engorged paraumbilical veins associated with portal hypertension
When may you see caput medusae?
liver cirrhosis
When may you see striae?
- ascites
- intrabdominal malignancy
- Cushing’s syndrome
- obesity
- pregnancy
How can you see hernias?
ask the patient to cough and observe for any protrusions through the abdominal wall (e.g. umbilical hernia, incisional hernia)
What is Cullen’s sign and what does it mean?
bruising of the tissue surrounding the umbilicus associated with haemorrhagic pancreatitis (a late sign)
What is Grey-Turner’s sign? What does it mean?
bruising in the flanks associated with haemorrhagic pancreatitis (a late sign)
If a stoma is present what do you comment on?
- location
- contents
- consistency of stool
- spout
What stomas are usually in the left iliac fossa?
colostomies
What stomas are usually in the right iliac fossa?
ileostomies and urostomies
What can the contents of stomas be?
- stool (colostomy or ileostomy)
2. urine (urostomy)
What are the different consistency of stool in a stoma?
- liquid (ileostomy)
2. solid (colostomy)
Which stomas have a spout?
ileostomies and urostomies (not colostomies)
What condition has rebound tenderness?
non-specific but peritonitis e.g. appendicitis
When may patient be guarding?
peritonitis (appendicitis and diverticulitis)
What is Rovsing’s sign?
palpation of the left iliac fossa causes pain to be experienced in the right iliac fossa
What is Rovsing’s sign shown for?
unreliable - appendicitis but best indicates peritoneal inflammation of any cause affecting the left and/or right iliac fossa.
If you find a mass during palpitation what do you mention?
- Location
- size and shape
- consistency
- mobility
- pulsatility
If you can feel the liver edge what should you comment on?
- degree of extension below the costal margin
2. consistency of live
What does it mean if the costal margin is greater than 2cm?
hepatomegaly
What would a nodular consistency of the liver edge suggest?
cirrhosis
What would hepatic tenderness suggest?
hepatitis or cholecystitis (as you may be palpating the gallbladder)
What is pulsatile hepatomegaly associated with?
tricuspid regurgitation
