Abdominal Examination Flashcards
What must you specifically ask a patient prior to an abdominal examination?
Whether patient has pain anywhere in abdomen
What may you be looking for during an end of bed inspection?
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
What is clubbing indicative of (specific to abdominal examination)?
IBD
Cirrhosis
Coeliac
What is koilonychia indicative of?
Spoon nails
Chronic iron deficiency
What is leukonychia indicative of?
‘Milk spots’
Liver failure
Enteropathy
What is palmar erythema indicative of?
Reddening of palm
Liver disease
Pregnancy
What is Dupuytren’s Contracture indicative of?
Thickening of palmar fascia
Alcohol excess
Family history
What is a hepatic flap indicative of?
Hepatic encephalopathy
Uraemia
CO2 retention
What features are looked for in eyes?
Pallor conjuctivae
Upper sclera jaundice
What are mouth ulcers indicative of?
Crohn’s Disease
Coeliac Disease
What is glossitis indicative of?
iron/ B12 deficiency
What is Virchow’s node and its relevance?
Should check for raised lymph node in the left supraclavicular fossa.
Indicative of gastric malignancy
What chest features should be identified (if present)?
Spider Naevi - chronic liver disease
Gynaecomastia - overdevelopment of male breast tissue indicative of liver cirrhosis/ spironolactone
What features should be looked for in the mouth?
Glossitis
Gingivitis
Ulcers
Smell (hepatic foeter, DKA, ethanol)
What features should be identified (if present) in the nails?
Leuconychia
Koilonychia
Clubbing
What features should be identified (if present) on the hands?
Palmar erythema
Liver flap
Dupuytren’s contracture
What should be identified when inspecting the abdomen?
Peristalsis
Pigmentation
Pulsation
What should be percussed?
Nine regions Liver edge Spleen Shifting dullness (ascites) Bladder
What should be auscultated?
Four quadrants for bowel sounds Renal bruits (diagonally from umbilicus)
How should a patient be positioned for examination?
Lying flat (with 1 pillow beneath head) Abdomen exposed
What should be done at the beginning of the consultation?
Wash hands
Introduction
Patient Consent
Explanation
Which vital signs should be done?
Radial pulse (rate and rhythm)
What features should be examined in the neck?
Lymph nodes (palpation) Distended veins (inspection)
How should the abdomen be palpated?
Nine regions - superficial (tenderness/ guarding) and deep (masses) Liver Spleen Kidneys Aortic Aneurysm
What additional tests could be done following an abdominal examination?
Rectal examination
External genitalia examination
Blood glucose
Stool/ urine sample
Where would oedema be identified if present?
Peripheral oedema - lower legs/ ankles
Sacral oedema
