Abdominal examination

Question 1

GI symptoms

Answer 1

Weight loss
Anorexia
Dysphagia
N and V
Altered bowel habit
PR bleeding
Haematemesis
Abdo pain
Abdo distension
Fatigue/ SOB

Question 2

5 steps of GI exam

Answer 2

Inspection
Palpation
Percussion
Auscultation
Special tests

Question 3

Special tests in GI examination

Answer 3

Transillumination

Shifting dullness

Question 4

Observations from the end of the bed

Answer 4

Pain
Tachypnoea
Jaundice/cyanosed
Body habitus

Question 5

Hand signs

Answer 5

Koilonychia
Leukonychia
Nail clubbing
Palmar erythema
Dupuytrens contracture
Liver flap

Question 6

What can cause palmer erythema and leukonychia

Answer 6

Liver disease

Question 7

Eye signs

Answer 7

Jaundice
Anaemia
Xanthelasma
Kayser fleischer rings

Question 8

Who pulls the eye lid down

Answer 8

Ask the patient to

Question 9

Mouth signs

Answer 9

Angular cheilitis
Glossitis
Mouth ulcers

Question 10

Chest signs

Answer 10

Spider naevi
Gynaecomastia
Supraclavicular lymph nodes

Question 11

How do you test for spider naevi

Answer 11

Press on the centre and it will blanch from outside in

Question 12

Things to look for when the patient is lying flat

Answer 12

Scars, massess, pulsations
Stomas
Drains
Catheters
Caput medusae

Question 13

5 causes of abdominal distension

Answer 13

Fat
Fluid
Faeces
Flatus
Foetus

Question 14

4 things of stomas

Answer 14

Site
Type of bowel
Content
Type of bag

Question 15

Cullens sign and grey turners sign

Answer 15

Appendicitis

Question 16

Periumbilical bruising

Answer 16

Cullens

Question 17

Retrosternal flank bruising

Answer 17

Grey turners

Question 18

What should you do before palpating

Answer 18

Ask where the patient is most sore, and start far away

Question 19

How do you palpate

Answer 19

Hand flat over each area and flex at the MCP. Look at the patients face

Question 20

Where do you palpate

Answer 20

9 areas, deep then soft, liver, spleen, kidneys, AA, bladder

Question 21

Liver

Answer 21

Deep breaths, 1cm below costal margin

Question 22

How do you measure enlarged liver

Answer 22

How many finger breaths below the costal margin

Question 23

What is murphys sign

Answer 23

RUQ tender. Breath in and pain under costal margin. Cholecystitis.

Question 24

Spleen

Answer 24

Start at RIF, if you feel then it is enlarged

Question 25

Kidneys

Answer 25

One on top, one underneath and push up with the lower hand. Enlarged if can feel or theyre thin

Question 26

Big spleen signs

Answer 26

``` Cant get above Can cross midline Splenic notch Moves down on inspiration Cannot ballot the spleen ```

Question 27

Big kidney signs

Answer 27

Can get above Doesnt cross midline Doesnt move on inspiration Ballotable

Question 28

Bladder

Answer 28

Palpable when >300ml. Can

Question 29

Rosvigs sign

Answer 29

Palpation in the LIF results in pain in the RIF. Can indicate appendicits

Question 30

Where do you percuss

Answer 30

Liver, spleen bladder

Question 31

Liver percussion

Answer 31

6th rib downwards then umbilicus up. Until resonant goes to dull

Question 32

Spleen percussion

Answer 32

Left anterior axillary line, lowest intercostal space. If changes from resonant to dull on inspiration then splenomegaly

Question 33

Bladder percussion

Answer 33

From umbilicus to pubic symphis. Wait from resonant to dull

Question 34

Shifting dullness

Answer 34

Wait for resonance change then get them to move over. If dullness has moved then indicates fluid

Question 35

Auscultation

Answer 35

Bowel sounds and describe them. Abdominal and femoral bruits.

Question 36

To complete the examination | ISHRUG

Answer 36

``` Inguinal lymph nodes Stools Hernial orrifices Rectal examination Urinalysis Genitalia ```

Question 37

Technique of DRE

Answer 37

Left lateral or nee elbow position. Gloved, well lubricated finger

Question 38

Assess on DRE

Answer 38

Perineal skin, anal tone, rectal contents, prostate, cervix

Question 39

4 questions for scrotal swellings

Answer 39

get above? normal testes? tender? transilluminate?

Question 40

What is it if you cant get above

Answer 40

Tumour Tense hydrocele Orchitis Hernia

Question 41

What if you can get above

Answer 41

True scrotal swelling

Question 42

If it is a true scrotal

Answer 42

Can you transilluminate

Question 43

Cant feel above but does transilluminate

Answer 43

Hydrocele

Question 44

Cant get above and cant transilluminate

Answer 44

Spermatocele Epididymitis Epididymal tumour TB

Question 45

Cant get above and cant transilluminate

Answer 45

Spermatocele Epididymitis Epididymal tumour TB

Question 46

Right upper name

Answer 46

Right hypochondrium

Question 47

Right middle name

Answer 47

Right lumbar

Question 48

Right lower name

Answer 48

Right iliac fossa

Question 49

Middle upper name

Answer 49

Epigastrium

Question 50

Middle middle name

Answer 50

Umbilical

Question 51

Middle lower name

Answer 51

Hypogastric, suprapubic

Question 52

Left upper name

Answer 52

Left hyperchondrium

Question 53

Left middle name

Answer 53

Left lumbar/flank

Question 54

Left lower name

Answer 54

Left iliac fossa

Question 55

What is an enlarged left supraclavicular lymph node

Answer 55

Virchows node, troisiers sign. Met from GI cancer

Question 56

What is cassels method

Answer 56

``` Breathe in Hold breathe Tap Breathe out Hold breathe Tap ```

Question 57

What are you auscultating on abdo exam

Answer 57

Renal Aortic Femoral

Question 58

Abdominal conclusion

Answer 58

Abdomen was soft and non tender with no palpable masses. Aorta pulsatile and not expansile. No bruits. No organomegaly on palpation and percussion