Abdominal Examination 3

Question 1

What are some causes of hepatomegaly?

Answer 1

1. Hepatitis (infective and non-infective)
2. Hepatocellular carcinoma
3. Hepatic metastases
4. Wilson’s disease
5. Haemochromatosis
6. Leukaemia
7. Myeloma
8. Glandular fever
9. Primary biliary cirrhosis
10. Tricuspid regurgitation
11. Haemolytic anaemia

Question 2

What would a palpable gallbladder suggest?

Answer 2

1. enlargement secondary to biliary flow obstruction (e.g. pancreatic malignancy, gallstones)
2. and/or infection (e.g. cholecystitis)

Question 3

What is Murphy’s sign?

Answer 3

1. Position your fingers at the right costal margin in the mid-clavicular line at the liver’s edge.
2. Ask the patient to take a deep breath.

Question 4

What is Murphy’s sign positive?

Answer 4

patient suddenly stops mid-breath due to pain, this suggests the presence of cholecystitis

Question 5

What are causes of splenomegaly?

Answer 5

1. Portal hypertension secondary to liver cirrhosis
2. Haemolytic anaemia
3. Congestive heart failure
4. Splenic metastases
5. Glandular fever

Question 6

What would bilaterally enlarged kidney suggest?

Answer 6

1. polycystic kidney disease

2. amyloidosis

Question 7

What is a unilaterally enlarged ballotable kidney caused by?

Answer 7

renal tumour

Question 8

What are tinkling bowel sounds suggestive of?

Answer 8

bowel obstruction

Question 9

What would absent bowel sounds be because of?

Answer 9

• ileus
• due to electrolyte abnormalities and recent abdominal surgery
• need to listen for 3 mins to decide

Question 10

What would pitting oedema on lungs suggest?

Answer 10

hypoalbuminaemia (e.g. liver cirrhosis, protein-losing enteropathy)

Question 11

What would a bruit with aortic bruits suggest?

Answer 11

AAA

Question 12

What would a bruits near renal bruits suggest?

Answer 12

renal artery stenosis