Abdominal Examination

Question 1

What must you specifically ask a patient prior to an abdominal examination?

Answer 1

Whether patient has pain anywhere in abdomen

Question 2

What may you be looking for during an end of bed inspection?

Answer 2

Treatments (e.g. stoma bag, drains)
Patient's appearance (e.g. agitated, confused) 
Body habitus (e.g. BMI)
Scars/ wounds/ dressings 
Obvious signs of jaundice/ anaemia

Question 3

What is clubbing indicative of (specific to abdominal examination)?

Answer 3

IBD
Cirrhosis
Coeliac

Question 4

What is koilonychia indicative of?

Answer 4

Spoon nails

Chronic iron deficiency

Question 5

What is leukonychia indicative of?

Answer 5

‘Milk spots’
Liver failure
Enteropathy

Question 6

What is palmar erythema indicative of?

Answer 6

Reddening of palm
Liver disease
Pregnancy

Question 7

What is Dupuytren’s Contracture indicative of?

Answer 7

Thickening of palmar fascia
Alcohol excess
Family history

Question 8

What is a hepatic flap indicative of?

Answer 8

Hepatic encephalopathy
Uraemia
CO2 retention

Question 9

What features are looked for in eyes?

Answer 9

Pallor conjuctivae

Upper sclera jaundice

Question 10

What are mouth ulcers indicative of?

Answer 10

Crohn’s Disease

Coeliac Disease

Question 11

What is glossitis indicative of?

Answer 11

iron/ B12 deficiency

Question 12

What is Virchow’s node and its relevance?

Answer 12

Should check for raised lymph node in the left supraclavicular fossa.
Indicative of gastric malignancy

Question 13

What chest features should be identified (if present)?

Answer 13

Spider Naevi - chronic liver disease

Gynaecomastia - overdevelopment of male breast tissue indicative of liver cirrhosis/ spironolactone

Question 14

What features should be looked for in the mouth?

Answer 14

Glossitis
Gingivitis
Ulcers
Smell (hepatic foeter, DKA, ethanol)

Question 15

What features should be identified (if present) in the nails?

Answer 15

Leuconychia
Koilonychia
Clubbing

Question 16

What features should be identified (if present) on the hands?

Answer 16

Palmar erythema
Liver flap
Dupuytren’s contracture

Question 17

What should be identified when inspecting the abdomen?

Answer 17

Peristalsis
Pigmentation
Pulsation

Question 18

What should be percussed?

Answer 18

Nine regions 
Liver edge 
Spleen 
Shifting dullness (ascites) 
Bladder

Question 19

What should be auscultated?

Answer 19

Four quadrants for bowel sounds 
Renal bruits (diagonally from umbilicus)

Question 20

How should a patient be positioned for examination?

Answer 20

Lying flat (with 1 pillow beneath head) 
Abdomen exposed

Question 21

What should be done at the beginning of the consultation?

Answer 21

Wash hands
Introduction
Patient Consent
Explanation

Question 22

Which vital signs should be done?

Answer 22

Radial pulse (rate and rhythm)

Question 23

What features should be examined in the neck?

Answer 23

Lymph nodes (palpation) 
Distended veins (inspection)

Question 24

How should the abdomen be palpated?

Answer 24

Nine regions - superficial (tenderness/ guarding) and deep (masses) 
Liver 
Spleen
Kidneys 
Aortic Aneurysm

Question 25

What additional tests could be done following an abdominal examination?

Answer 25

Rectal examination
External genitalia examination
Blood glucose
Stool/ urine sample

Question 26

Where would oedema be identified if present?

Answer 26

Peripheral oedema - lower legs/ ankles

Sacral oedema