Abdominal examination Flashcards
What clinical signs should you inspect for from the end of the bed?
Age Confusion Pain Obvious scars Abdominal distension Pallor Jaundice Hyperpigmentation Oedema Cachexia Hernias
Why should you inspect for signs of confusion before an abdominal examination?
Confusion is often a feature of end-stage liver disease, known as hepatic encephalopathy
Why is age important to an abdominal examination?
Younger patients are more likely to have IBD. Older patients are more likely to have chronic liver disease and malignancy
What may abdominal distension suggest?
The presence of ascites or underlying bowel obstruction and/or organomegaly
What are 4 possible causes of jaundice?
Acute hepatitis, liver cirrhosis, cholangitis and pancreatic cancer
What causes hyperpigmentation?
Haemochromatosis
What objects and equipment may be noteworthy on inspection of the room?
Stoma bag(s) Surgical drains Feeding tubes ECG leads Catheters Mobility aids
What 3 things do you look for on inspection of the palms in an abdominal examination?
Pallor
Palmar erythema- associated with chronic liver disease
Dupuytren’s contracture
What are the 3 nail signs to look for on inspection of the hands in an abdominal examination?
Koilonychia- spoon-shaped nails associated with iron-deficiency anaemia (e.g. malabsorption in Crohn’s disease)
Leukonychia- whitening of the nail bed, associated with hypoalbuminaemia (e.g. end-stage liver disease)
Clubbing
What are the most likely causes of clubbing in an abdominal examination?
IBD, coeliac disease, liver cirrhosis and lymphoma of the GI tract
Why is testing for CO2 retention flap important to an abdominal examination?
It can be caused by hepatic encephalopathy due to hyperammonaemia, or by uraemia secondary to renal failure
What 3 things do you palpate at the hands and wrists for in an abdominal examination?
Temperature
Radial pulse
Dupuytren’s contracture
How do you assess for Dupuytren’s contracture?
Support the patient’s hand and palpate the palm to detect bands of thickened palmar fascia that feel cord-like
What do you inspect for on the patient’s arms in an abdominal examination?
Bruising- may indicate clotting abnormalities secondary to cirrhosis
Excoriations- scratches that can suggest cholestasis
Needle track marks- IV drug use can be associated with an increased risk of hepatitis
What do you inspect for on the patient’s axillae in an abdominal examination?
Acanthosis nigricans- hyperpigmentation and hyperkeratosis of axillary skin. Can be benign, or associated with insulin resistance or GI malignancy
Hair loss- associated with iron-deficiency anaemia and malnutrition
Name 6 signs to look for in the eyes of your patient in an abdominal examination
Conjunctival pallor Jaundice Kayser-Fleischer rings Xanthelasma Corneal arcus Perilimbal injection
What is perilimbal injection?
Inflammation of the area of conjunctiva adjacent to the iris.
A sign of anterior uveitis, which can be associated with inflammatory bowel disease
Name 5 signs to inspect for when checking the patient’s mouth in an abdominal examination
Angular stomatitis Oral candidiasis Glossitis Aphthous ulceration Hyperpigmented macules
What is one of the first clinical signs of metastatic intraabdominal malignancy, discoverable on palpation of the lymph nodes of the neck?
Lymphadenopathy of the left supraclavicular lymph node (Virchow’s node), as this is the node that receives lymphatic drainage from the abdominal cavity
What 3 signs should you look for on inspection of the patient’s chest in an abdominal examination?
Spider naevi
Gynaecomastia
Hair loss
