Abdominal examination Flashcards
GI symptoms
Weight loss Anorexia Dysphagia N and V Altered bowel habit PR bleeding Haematemesis Abdo pain Abdo distension Fatigue/ SOB
5 steps of GI exam
Inspection Palpation Percussion Auscultation Special tests
Special tests in GI examination
Transillumination
Shifting dullness
Observations from the end of the bed
Pain
Tachypnoea
Jaundice/cyanosed
Body habitus
Hand signs
Koilonychia Leukonychia Nail clubbing Palmar erythema Dupuytrens contracture Liver flap
What can cause palmer erythema and leukonychia
Liver disease
Eye signs
Jaundice
Anaemia
Xanthelasma
Kayser fleischer rings
Who pulls the eye lid down
Ask the patient to
Mouth signs
Angular cheilitis
Glossitis
Mouth ulcers
Chest signs
Spider naevi
Gynaecomastia
Supraclavicular lymph nodes
How do you test for spider naevi
Press on the centre and it will blanch from outside in
Things to look for when the patient is lying flat
Scars, massess, pulsations Stomas Drains Catheters Caput medusae
5 causes of abdominal distension
Fat Fluid Faeces Flatus Foetus
4 things of stomas
Site
Type of bowel
Content
Type of bag
Cullens sign and grey turners sign
Appendicitis
Periumbilical bruising
Cullens
Retrosternal flank bruising
Grey turners
What should you do before palpating
Ask where the patient is most sore, and start far away
How do you palpate
Hand flat over each area and flex at the MCP. Look at the patients face
Where do you palpate
9 areas, deep then soft, liver, spleen, kidneys, AA, bladder
Liver
Deep breaths, 1cm below costal margin
How do you measure enlarged liver
How many finger breaths below the costal margin
What is murphys sign
RUQ tender. Breath in and pain under costal margin. Cholecystitis.
Spleen
Start at RIF, if you feel then it is enlarged
Kidneys
One on top, one underneath and push up with the lower hand. Enlarged if can feel or theyre thin
Big spleen signs
Cant get above Can cross midline Splenic notch Moves down on inspiration Cannot ballot the spleen
Big kidney signs
Can get above
Doesnt cross midline
Doesnt move on inspiration
Ballotable
Bladder
Palpable when >300ml. Can
Rosvigs sign
Palpation in the LIF results in pain in the RIF. Can indicate appendicits
Where do you percuss
Liver, spleen bladder
Liver percussion
6th rib downwards then umbilicus up. Until resonant goes to dull
Spleen percussion
Left anterior axillary line, lowest intercostal space. If changes from resonant to dull on inspiration then splenomegaly
Bladder percussion
From umbilicus to pubic symphis. Wait from resonant to dull
Shifting dullness
Wait for resonance change then get them to move over. If dullness has moved then indicates fluid
Auscultation
Bowel sounds and describe them. Abdominal and femoral bruits.
To complete the examination
ISHRUG
Inguinal lymph nodes Stools Hernial orrifices Rectal examination Urinalysis Genitalia
Technique of DRE
Left lateral or nee elbow position. Gloved, well lubricated finger
Assess on DRE
Perineal skin, anal tone, rectal contents, prostate, cervix
4 questions for scrotal swellings
get above?
normal testes?
tender?
transilluminate?
What is it if you cant get above
Tumour
Tense hydrocele
Orchitis
Hernia
What if you can get above
True scrotal swelling
If it is a true scrotal
Can you transilluminate
Cant feel above but does transilluminate
Hydrocele
Cant get above and cant transilluminate
Spermatocele
Epididymitis
Epididymal tumour
TB
Cant get above and cant transilluminate
Spermatocele
Epididymitis
Epididymal tumour
TB
Right upper name
Right hypochondrium
Right middle name
Right lumbar
Right lower name
Right iliac fossa
Middle upper name
Epigastrium
Middle middle name
Umbilical
Middle lower name
Hypogastric, suprapubic
Left upper name
Left hyperchondrium
Left middle name
Left lumbar/flank
Left lower name
Left iliac fossa
What is an enlarged left supraclavicular lymph node
Virchows node, troisiers sign. Met from GI cancer
What is cassels method
Breathe in Hold breathe Tap Breathe out Hold breathe Tap
What are you auscultating on abdo exam
Renal
Aortic
Femoral
Abdominal conclusion
Abdomen was soft and non tender with no palpable masses. Aorta pulsatile and not expansile. No bruits. No organomegaly on palpation and percussion
