Abdominal Examination Flashcards
On general inspection, what are you looking for?
Pain or discomfort
Abdominal distention
Obesity
Pallor
Colour (jaundiced?)
Muscle wasting
Scratch marks
Spider nave
Purpura
On general inspection, what are you looking for around the bed?
Abdominal drains, dressings, vomit bowl, medications
On inspection and assessment of the hands and arms, what are you looking for?
Finger clubbing
Leuchonychia (white nails)
Koilonychia
Palmar erythema
Dupuytren’s contracture
Purpura
Fistulae
Tunnelled lines
Spider naevi in upper arm
Injection marks
What are abdominal causes of clubbing?
Cirrhosis
Ulcerative colitis
Crohn’s disease
Coeliac disease
What can cause palmar erythema?
Increased circulating levels of oestrogens
Can be found in liver disease, pregnancy and oestrogen contraceptive pill
In what conditions may Dupuytren’s contracture be found?
Cirrhosis of liver
Diabetes
Alcohol dependence
What might a flapping tremor indicate?
Decompensated liver failure (hepatic encephalopathy)?
On inspection of the eyes, what are you looking for?
Xanthelasma
Jandice
Pallor (anaemia)
What might xanthelasma indicate?
Prolonged cholestasis e.g. in primary biliary cirrhosis
On inspection of the mouth, what are you looking for?
Ulcers
Pigmentation
Telangiectasia
Stomatitis
Glossitis
Poor dentition
Gingivitis
Candidiasis
Tonsillar infection
Note any odours
What might pigmentation of the lips indicate?
Peutz-Jehger’s Syndrome
What might telangiectasia indicate?
Hereditary Haemorrhagic Telangiectasia
Why are telangiectasia important to identify?
They can also occur in the gut, lung and nose and cause severe bleeding
What are stomatitis and glossitis evidence of?
Iron deficiency anaemia
What kind of ulcers may occur in crops?
Herpetic
What kind of ulcers are common and painful?
Aphthous ulcers
What should a painless non-healing ulcer alert you to?
Squamous cell carcinoma
Why should you check the breath for odors?
Alcohol
Vomit
DKA
On inspection of the chest and axillae, what are you looking for?
Spider naevi
Gynaecomastia in men
Axillae for loss of axillary body hair
What might cause gynaecomastia and loss of axillary hair in men?
Chronic liver disease (increased circulating oestrogens and decreased testosterone)
On close inspection of the abdomen, what are you looking for?
Symmetry
Visible peristalsis
Absence of movement with respiration
Distention (fluid, flatus, fat, foetus, faeces)
Herniae
Stromas and scars
Striae
Distended veins
Scratch marks
Pulsations in abdomen
Grey Turner’s Sign (discolouration/ bruising in flanks)
Cullen’s Sign (umbilicus)
What results in no visible movement with respiration?
Peritonitis (abdominal rigidity)
What is a cause of striae other than pregnancy?
Cushing’s Syndrome
When may distended veins be present?
Portal hypertension in chronic liver disease and in IVC obstruction
When may scratch marks be present?
Jaundice (bile salts deposited in tissue leading to pruritis)
What causes Turner’s Sign?
Bleeding within abdomen e.g. haemorrhage pancreatitis, ruptured aneurysm, ectopic pregnancy
What are the 9 regions of the abdomen?
Right hypochondrium, epigastrium, left hypochondrium
Right lumbar, umbilical, left lumbar
Right iliac fossa, suprapubic, left iliac fossa
What is Murphy’s Sign?
Intense pain and arrest of inspiration as inflamed gallbladder descends and contacts fingers
What do absent bowel sounds suggest?
Paralytic ileum or, if abdomen is rigid, peritonitis
What does a tinkling bowel sound suggest?
Obstruction
What do you look/ feel for when you sit the patient forward to inspect their back?
Spider naevi
Renal scars
Palpate renal angle for renal tenderness
Palpate neck for cervical lymphadenopathy
What is Virchow’s node?
A lymph node in the lower part of the left posterior cervical triangle containing a metastasis.
What is the finding of Virchow’s node?
Troisier’s Sign
What is Troisier’s Sign a sign of?
Stomach cancer or lung, head or neck cancer
What other tests would you offer?
Inspection and examination of groin for hernias and lymphadenopathy
Examination of external genitalia
Digital rectal examination
Observation chart
Urine Dipstix
