Abdominal Examination

Question 1

General Inspection

Answer 1

Treatments/adjuncts - feeding tubes, stoma bags, drains
Appearance - pain, agitation, confusion
Body habits - obese, low BMI, cachexia
Scars
Jaundice - cirrhosis, hepatitis
Anaemia - anaemia, GI bleeding
Abdominal distension - ascites, bowel distension, large masses
Masses - malignancy, orgnomegaly, pregnancy
Dressings - infection, bleeding
Needle track marks - IVDU, HIV, hepatitis
Excoriations - cholestasis

Question 2

Hands inspection

Answer 2

Clubbing - IBD, cirrhosis, coeliac disease
Koilonychia - chronic iron deficiency
Leukonychia - hypoalbuminaemia (liver failure)
Palmar erythema - liver disease, pregnancy
Dupuytrens Contracture - alcohol excess, family history
Hepatic Flap - hepatic encephalopathy, uraemia, CO2 retention

Question 3

Arms inspection

Answer 3

Bruising - abnormal coagulation, liver failure
petechiae - splenomegaly
excoriations - cholestasis
track marks - HIV, hepatitis

Question 4

Eyes inspection

Answer 4

xanthelasma - hyperlipidaemia
conjunctival pallor - anaemia
jaundice - haemolysis, hepatitis, cirrhosis, biliary obstruction

Question 5

Mouth Inspection

Answer 5

angular stomatitis - iron/B12 deficiency
oral candidiasis - iron deficiency, immunodeficiency, steroids
mouth ulcers - crowns, coeliac
glossitis - iron/B12/folate deficiency

Question 6

Neck inspection

Answer 6

cervical lymph nodes - infection, malignancy

Virchow’s Node - gastric malignancy

Question 7

Chest inspection

Answer 7

Spider Naevi (>5) - chronic liver disease
Gynaecomastia - spironolactone, cirrhosis
Hair changes - malnourishment, iron deficiency anaemia

Question 8

Abdomen Inspection

Answer 8

scars
stomas - colostomy, ileostomy
masses - organomegaly, malignancy, hernias
distension - ascites, obesity, constipation, pregnancy, flatus
striae - distension
pulsations - AAA
caput medusa - portal hypertension
grey turners sign - ruptured AAA, pancreatitis
cullers sign - ruptured AAA, pancreatitis

Question 9

Abdominal palpation

Answer 9

light and deep - tenderness, masses, guarding, rebound
splenomegaly
hepatomegaly
abdominal aorta - pulsatile? expansile?
kidneys

Question 10

Percussion

Answer 10

tenderness
liver and spleen
ascites - shifting dullness

Question 11

Auscultation

Answer 11

bowel sounds
renal bruits
aortic bruits

Question 12

Further Investigations

Answer 12

PR examination
Hernial Orifices
Abdominal and Chest Xray