Abdominal Examination Flashcards
1
Q
What sort of monitoring devices should you look for in the general inspection of an abdominal examination?(3)
A
Catheter/urometer
Pulse oximeter
Surgical drains
2
Q
What sort of treatments should you look for in the general inspection of an abdominal examination?(8)
A
Oxygen specs/mask (method of delivery, rate, SATs) NG tube, IV fluids/ antibiotics
TPN lines
Central lines
PCA pump Ensure drinks Bottles of Creon
3
Q
What sort of paraphernalia should you look for in the general inspection of an abdominal examination?(3)
A
Food and drink
Nil by mouth (NBM) signs Vomit bowels
4
Q
What is leukonychia a sign of?
A
Hypoalbuminaemia which can be due to chronic liver disease
5
Q
What may hypoalbuminaemia be due to?
A
Chronic liver disease
6
Q
What is a sign of hypoalbuminaemia and may be due to chronic liver disease you can see in the hands?
A
Leukonychia
7
Q
What is koilonychia?
A
Spoon-shaped nails
8
Q
What are white nails known as?
A
Leukonychia
9
Q
What are white nails a sign of?
A
Sign of hypoalbuminaemia and may be due to chronic liver disease
10
Q
What causes koilonychia?
A
Severe iron deficiency
11
Q
What does severe iron deficiency cause in nails?
A
Koilonychia
12
Q
What signs can you look for in the nails for abdominal disease? (3)
A
Clubbing, koilonychia, leukonychia
13
Q
What signs can you look for in the patients palms for abdominal disease?(3)
A
Pale palmar creases
Palmar erythema
Dupuytren’s contracture
14
Q
What do pale palmar creases signify?
A
May signify anaemia
15
Q
What is palmar erythema?
A
Red palms
16
Q
What are red palms known as?
A
Palmar erythema
17
Q
What sign in the palm signifies anaemia?
A
Pale palmar creases
18
Q
What are spoon-shaped nails known as?
A
Koilonychia
19
Q
What is palmar erythema a sign of?(3)
A
Chronic liver disease
Pregnancy
Hyperthyroidism
20
Q
What is Dupuytrens contracture?
A
Thickening of the palmar fascia especially of the little and ring fingers
21
Q
What sign is in the palms of the hands for pregnancy?
A
Palmar erythema
22
Q
What sign is in the palms of the hands for chronic liver disease?
A
Palmar erythema
23
Q
What sign is in the palms of the hands for hyperthyroidism?
A
Palmar erythema
24
Q
Which fingers are especially affected by Dupuytrens contracture?
A
Little and rings finger
25
What is Dupuytrens contracture associated with? (6)
Alcoholism, smoking, epilepsy, diabetes, repeated trauma, and family history
26
What can a tremor in arms held out indicate?
Alcohol withdrawal
27
What sign can you use to test for alcohol withdrawal?
Look for a tremor in arms held out straight in front
28
What is CO2 retention also known as?
Hypercapnia
29
What is hypercapnia?
CO2 retention
30
What should you examine the arms for in an abdominal examination? (3)
Blood pressure
Signs of intravenous drug use
Arterio-venous fistulae
31
When seeing signs of IV drug use, what abdominal disease should you be more conscious of?
Hepatitis
32
What sign in the arms could indicate hepatitis?
Signs of IV drug use
33
What is arterio-venous fistulae indicative of?
Renal replacement therapy
34
If arterio-venous fistulae are found when examining the arms what should you do and why? (3)
Look at it ( needle marks indicate it is still in use) palpate it (if hard it may be thrombosed so not working) and auscultate it (a thrum likely indicates still active)
35
What sign should you look for for indication of renal replacement therapy?
Arterio-venous fistulae
36
What sign are you looking for when pulling down the lower eyelid?
Conjunctival pallor
37
What is conjunctival pallor a sign of?
Anaemia
38
What sign of anaemia can you see in the lower eyelid?
Conjunctival pallor
39
What is scleral icterus?
The yellow colour of the eyes in jaundice
40
What is the yellow colour in the eyes in jaundice from?
From the conjunctiva, not in fact the sclera, being stained by bile pigment, nevertheless it is commonly referred to as scleral icterus
41
In which disease can you see Kayser-Fleischer rings?
Wilson's disease
42
What is Wilson's disease?
An autonomic recessive copper storage disorder
43
What are Kayser-Fleischer rings?
Where excess copper is deposited in Descemet’s membrane to form brownish- green rings at the periphery of the cornea
44
What are the rings caused by excess copper being deposited in Descemet’s membrane to form brownish- green rings at the periphery of the cornea known as?
Kayser- Fleischer rings
45
What are xanthelasma?
Yellow periorbital plaques due to lipid deposition, which may occur in chronic cholestasis
46
What sign can you spot in the eye from chronic cholestasis?
Xanthelasma
47
What can cause xanthelasma?
Chronic cholestasis
48
What is another name for angular cheilitis?
Angular stomatitis
49
What is another name for angular stomatitis?
Angular cheilitis
50
What is angular cheilitis associated with?
Iron deficient anaemia
51
What underlying medical condition can ulceration within the mouth indicate?(3)
Crohn’s disease, coeliac disease or reactive arthritis
52
How does the tongue appear in atrophic glossitis?
Beefy, red and raw
53
How does the tongue appear in vitamin B12 deficiency?
Pale and smooth
54
What condition causes the tongue to appear pale and smooth?
?
55
What condition causes the tongue to appear beefy, red and raw?
Vit B12 deficiency
56
How can you detect fetor hepaticus?
Distinctive sweet smell on breath
57
What does a distinctive sweet smell on breath indicate?
Fetor hepaticus (commonly found in ketosis or severe liver disease, and is caused by the accumulation of volatile aromatic substances in the body)
58
What causes fetor hepaticus?
Commonly found in ketosis or severe liver disease, and is caused by the accumulation of volatile aromatic substances in the body
59
What 2 things can you detect on a patients breath?
Alcohol or the distinctive sweet smell of fetor hepaticus on the patient’s breath.
60
How can you detect ketosis or severe liver disease?
Fetor hepaticus
61
What is Troisiers sign?
The presence of a palpable metastatic scalene lymph node in the left supraclavicular fossa.
(Virchow's node)
62
What is the palpable metastatic scalene lymph node in the left supraclavicular fossa known as?
Troisier's sign/Virchow’s node
63
What causes Troisiers sign/Virchow's node?
Any abdominal or breast cancer, but is classic of gastric cancer.
64
What can be caused by any abdominal or breast cancer, but is classic of gastric cancer?
Troisiers sign/Virchow's node
65
What is itchy skin known as?
Pruritis
66
What is pruritis?
Itchy skin
67
What are scratch marks an indicator on?
Cholestatic liver disease
68
What is an indicator of cholestatic liver disease visible upon abdominal examination?
Scratch marks from pruritis
69
What is an indicator of liver disease visible upon abdominal examination?
Bruising
70
What is bruising in liver disease due to?
Impaired clotting factor production
71
What should you look for in and around the eye when doing an abdominal examination?(3)
Conjunctival pallor
Kayser- Fleischer rings
Xanthelasma
72
What should you look for in and around the mouth when doing an abdominal examination? (6)
```
Angular cheilitis
Ulceration
Pale and smooth tongue
Beefy, red and raw tongue
Fetor hepaticus
Alcohol smell
```
73
What clinical signs should you look for around the abdomen when doing an abdominal examination? (4)
Scratch marks
Bruising
Spider naevi
Gynaecomastia
74
How do you identify spider naevi?
Compression of the central arteriole will make the legs disappear completely
75
What is an abnormal number of spider naevi?
More than 5
76
What causes spider naevi?
Excess oestrogen due to reduced oestrogen metabolism in chronic liver disease
77
What can excess oestrogen due to reduced oestrogen metabolism in chronic liver disease cause?
Spider naevi and gynaecomastia
78
What is a good sign of excess oestrogen in men?
Gynaecomastia
79
What deformities should you look for in the abdomen? (5)
Scars, stomas, striae, sinuses, and fistulae.
80
What can cause striae? (Pathologically and diseases (2) and states (2))
Abnormal collagen formation (Cushing’s syndrome, Ehlers-Danlos syndrome)
Rapid skin growth (pregnancy, obesity)
81
What are sinuses and fistulae? (2)
Abnormal connections to the skin surface, often resulting from a deep infection, or infection of a surgical tract e.g. following laparoscopic surgery
82
What sign of a deep infection, or infection of a surgical tract should you be able to spot? (2)
Sinuses and fistulae
83
When spotting a stoma, what should you observe? (3)
The contents of the stoma bag, and whether the
| stoma is spouted or flush with the skin
84
When spotting a distended abdomen what should you ask the patient? Then what should you decide?
If the distension is normal
| Whether the distension is generalised or caused by a localised mass.
85
What is a useful tool to differentiate obesity from other diseases?
The umbilicus is a useful clue as it is usually sunken in obesity, and flat or everted in other conditions such as ascites
86
What disease can cause the abdomen to be distended?
Ascites
87
How can you identify peritonism?
Ask the patient to look to the side and cough. Then ask them to raise their head up from the bed by just a few degrees and hold that position for a few seconds before relaxing back into the supine position.
88
What are the abdominal wall hernias?(3)
Umbilical, incisional and spigelian hernias
89
What are umbilical hernias caused by?
From incomplete closure of the abdominal wall during foetal development and are often noted at birth as a protrusion at the umbilicus
90
What are incisional hernias caused by?
Result from abdominal surgery that causes a defect in the abdominal wall
91
What are spigelian hernias?
A rare type of hernia that occurs parallel to the midline of the abdomen, along the edge of the rectus abdominus muscle through the spigelian fascia.
92
What do dilated surface veins on the abdominal wall indicate?
Portal hypertension or vena caval obstruction
93
What is a sign of portal hypertension?
Dilated surface veins on the abdominal wall
94
What is a sign of vena canal obstruction?
Dilated surface veins on the abdominal wall
95
What is ‘caput medusa’
The name given to distended veins flowing away from the umbilicus
96
What is ‘caput medusa’ useful in indicating?
Cirrhosis
97
What may occasionally be visible if there is bowel obstruction?
Peristaltic bowel movements
98
What is important to ensure before starting an abdominal examination? (2)
That the patient is in the optimal position with their head relaxed on the couch and the the arms relaxed alongside the body. This ensures that the abdominal wall muscles are relaxed and not tense
And that you've asked if they have any pain anywhere
99
What should you do in the presence of pain during palpation?
Start as far away as possible from its maximal site, then move systematically through the nine regions of the abdomen lightly palpating each one in turn to a depth of approximately one centimetre until you reach the site of maximal pain
100
What should you always do whilst palpating the patient?
Watch their face for discomfort
101
What can tenderness be associated with?
Guarding
102
What are the two types of guarding?
```
Voluntary guarding (conscious contraction of the abdominal musculature in apprehensive patients anticipating a potentially painful clinical examination) and involuntary guarding
(localized peritoneal inflammation causing reflex contraction of overlying abdominal muscles upon palpation)
```
103
What causes involuntary guarding?
Localized peritoneal inflammation causing reflex contraction of overlying abdominal muscles upon palpation
104
How do you differentiate between voluntary and involuntary guarding?
By engaging the patient in conversation to divert their attention whilst palpating, which would reduce voluntary but not involuntary guarding.
105
What is generalised peritonitis?
Inflammation of the whole peritoneal cavity
106
How can you detect generalised peritonitis?
Widespread tenderness elicited by minimal pressure. The abdominal wall muscles are held rigid (‘board-like’) and breathing becomes increasingly thoracic.
107
What are board-like abdominal muscles and thoracic breathing indicative of?
Generalised peritonitis
108
What is a specific sign of peritonitis?
Rebound tenderness
109
What is rebound tenderness?
When the sudden withdrawal of manual pressure causes more pain than its application
110
What should you do instead of testing for rebound tenderness to cause less distress to the patient?
Light percussion
111
What is rebound tenderness indicative of?(2)
Peritonitis/appendicitis
112
How do you differentiate between a deep and superficial abdominal mass?
Ask the patient to tense their abdominal muscles by raising their head off the bed. If the mass is within the abdominal wall it will still be palpable whereas a deeper mass will not.
113
What should you describe if you can palpate a liver? (6)
Size, surface, edge, consistency, tenderness, and pulsatility
114
What can cause the gall bladder to become palpable? (2)
Obstruction of the cystic duct or common bile duct
115
What does the gall bladder feel like?
A bulbous, focal, rounded mass which moves downwards
| on inspiration.
116
What is Courvoisier's law?
In the presence of a palpable enlarged gallbladder which is non-tender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones.
117
What is the cause of a palpable enlarged gallbladder which is non-tender and accompanied with mild painless jaundice likely (2) and unlikely to be?
Unlikely to be gallstones and more likely to be due to carcinoma of the pancreas or distal cholangiocarcinoma
118
Why is a gallbladder which is non-tender and accompanied with mild painless jaundice unlikely to be due to gallstones?
The gallbladder classically becomes chronically fibrosed and thus incapable of enlargement
119
What is Murphy's sign indicative of?
Acute cholecytitis
120
What is a sign of acute cholecytitis?
Murphy's sign
121
What is Murphy's sign?
When palpating the gallbladder elicits a painful response in the patient but no pain on the other side and there is a sudden cessation of inspiration when the gallbladder reaches the fingers ('inspiratory arrest')
122
What sign is pain when palpating the gallbladder known as?
Murphy's sign
123
When can the spleen be palpated?
When it is threefold in size
124
What can help differentiate the kidney and the spleen upon palpation?
A characteristic notch may be felt midway along its leading edge that helps in differentiating the spleen from the kidney
125
What is balloting?
The technique used to palpate kidneys
126
What is the technique used to palpate kidneys known as?
Balloting
127
Kidneys are usually impalpable except in what conditions?(3)
Enlarged, abnormally low or very thin patients
128
What is palpation of the abdominal aorta usually used to detect?
Abdominal aortic aneurysm
129
What does bowel gas sound like under percussion?
Resonant
130
What do fluid filled structures sound like under percussion?
Dull
131
How do you detect non-hepatomegaly causes of a palpable liver? Examples? (3)
Percussion
| Emphysema or asthma or interposition of the transverse colon between the liver and the diaphragm
132
Why would an enlarged kidney be resonant to percussion but an enlarged spleen not?
Retroperitoneal structures and masses are resonant to percussion due to overlying bowel;
133
What is ascites?
Free fluid in the abdominal cavity
134
What is ascites mostly associated with?
Distension
135
What should you always try demonstrate when examining ascites? (2)
Shifting dullness or a fluid thrill
136
What should you try elicit when suspecting gastric outflow obstruction and distended stomach?
Succussion splash
137
What does a succussion indicate?
Distended stomach/gastric outflow obstruction
138
What is a succussion splash more than 4 hours after eating said to indicate?
Delayed gastric emptying as seen in pyloric stenosis
139
What is a sign of pyloric stenosis?
Succussion splash
140
What are normal bowel sounds?
Low-pitched gurgles occurring every 5-10 seconds although this can vary
141
How long must you listen for before concluding absent bowel sounds?
2 minute (some say 5)
142
What do absent bowel sounds indicate? (2)
Paralytic ileus or peritonitis
143
What are the bowel sounds of mechanical intestinal obstruction often described as?
High-pitched, tinkling quality
144
How do bowel sounds change in mechanical intestinal obstruction?
Increase in volume and frequency
145
What is a bruit?
An abnormal blowing or swishing sound resulting from blood flowing through a narrow or partially occluded artery
146
What is an abnormal blowing or swishing sound resulting from blood flowing through a narrow or partially occluded artery known as?
Bruit
147
Where should you listen for a bruit and what type?(2 and 1 with 3 with 3)
Above the umbilicus to listen for an aortic bruit
Above and lateral to the umbilicus to listen for renal artery bruits
Over the liver for bruits occurring in hepatoma or acute alcoholic hepatitis, or
for friction rubs caused by inflammation of the peritoneal surface of organs by tumour, infection or infarct.
148
What can cause a bruit in the liver?
Hepatoma or acute alcoholic hepatitis
