Abdominal Examination (Geeky Medics) Flashcards by Ben Jacobs

What treatment or adjuncts should you look for when carrying out a general inspection at the end of the bed?

feeding tubes
stoma bags
drains

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What should you look for in the patients appearance when doing a general inspection of the patient?

in pain?
agitated?
confused?

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What may be remarkable of the body habitus of the patient under general inspection?

obese?
low BMI?
cachetic?

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What scars present seen via general inspection on the patient could have clinical importance?

midline scars - laparotomy
RIF - appendectomy
right subcostal - cholecystectomy

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What are other patient signs could be seen in a general inspection that could be important? (7 - not including emotional state, body habitus and scars)

Jaundice - cirrhosis / hepatitis
Anaemia - obvious pallor suggests significant anaemia - e.g. GI bleeding
Abdominal distension - ascites / bowel distension / large masses
Masses - may suggest malignancy / organomegaly
Dressing - may be covering wound sites - infection / bleeding
Needle tract marks - hepatitis / HIV
Excoriations - pruritus - cholestasis

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What are the gastro causes of clubbing? (3)

inflammatory disease
cirrhosis
coeliac disease

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What is spooning of the nails called and what does it indicate?

• Koilonychia - chronic iron deficiency

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What is a whitened nail bed called, what is it and what does it indicate?

• leukonychia - hypoalbuminemia - liver failure / enteropathy

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What is a reddening of the palm called?

• Palmar erythema - liver disease / pregnancy

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What is Dupuytren’s contraction and what is it associated with?

Thickening of the fascia

* Alcohol excess / family history

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What can cause a hepatic flap? (3)

hepatic encephalopathy
uraemia
CO2 retention

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What may bruising of the arm suggest?

• abnormal coagulation time (increased prothrombin time) due to liver failure

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What is petechiae and what does it indicate? (arm)

a spotty red rash on the skin

* low platelets

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What is excoriations and what does it indicate? (arm)

A scratch mark

* cholestasis

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What could tract marks indicate? (arm)

intravenous drug use

* hepatitis / HIV

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What three signs could be found in the axillae the could indicate gastroenterology disease?

Lymphadenopathy - malignancy / infection
Hair loss - malnourishment / iron deficiency anaemia
Acanthosis nigricans (darkened pigmentation) - GI adenocarcinomas / obesity

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What is jaundice, where is the first signs of it and what does it indicate?

yellowing of the skin and the whites of the eyes caused by the build up of bilirubin in the blood and body tissues
Lower eyelids
haemolysis / hepatitis / cirrhosis / biliary obstruction

What does conjunctival pallor indicate?

• significant anaemia

What is Xanthelasma and what does it indicate?

raised yellow deposits surrounding the eyes

* Primary biliary cirrhosis (PBC) / hyperlipidaemia

What is inflamed areas at the corner of the mouth called and what does it indicate?

Angular stomatitis

* iron/B12 deficiency

What is oral candidiasis and what does it indicate?

white slough on oral mucous membranes

* iron deficiency / immunodeficiency

What may mouth ulcers indicate?

• Crohn’s disease / coeliac disease

What is glossitis and what might it indicate?

smooth swelling of the tongue with associated erythema

* iron/B12/folate deficiency

What could large cervical lymph nodes indicate?

lymphadenopathy

* infection / metastatic malignancy

What may be palpable in the left supraclavicular fossa and what may it indicate?

* Virchow's node | * gastric malignancy

What are spider naevi, where may they be found, how many present is significant and what can they indicate?

* central red spot with reddish extensions * chest * >5 * chronic liver disease

What is gynaecomastia and what may it indicate?

* overdevelopment of male mammary glands (pseudofeminisation) * liver cirrhosis / digoxin / spironolactone

What may hair loss on the chest indicate? (male)

• pseudofeminisation / malnourishment / iron deficiency

When carrying out a detailed abdominal inspection what may be found that could indicate gastroenterology disease? (9)

* Scars - midline (laparotomy) / RIF (appendectomy) / right subcostal (cholecystectomy) * Masses - assess (size, position, consistency, mobility) - organomegaly / malignancy * Pulsation - a central pulsatile & expansile mass - may indicate abdominal aortic aneurysm (AAA) * Cullen's sign - bruising surrounding umbilicus - retroperitoneal bleed (pancreatitis / ruptures AAA) * Grey-Turner's sign - bruising in the flanks - retroperitoneal bleed (pancreatitis / ruptured AAA) * Abdominal distension - fluid (ascites) / fat (obesity) / faeces (constipation) / flatus / fetus (pregnancy) * Striae - reddish/pink (new) or white/silverish (chronic) -abdominal distension * Caput medusa - engorged paraumbilical veins - portal hypertension * Stomas - colostomy (LIF) / ileostomy (RIF) / Urostomy (RIF and contains urine)

When lightly palpating the abdomen if the patient shows signs of rebound tenderness what could this indicate? What is rebound tenderness?

* peritonitis | * pain is worsened on releasing the pressure

When lightly palpating the abdomen the patient may by 'guarding,' what is this?

• involuntary tension in the abdominal muscles (is it localised or generalised?)

When lightly palpating the abdomen what should you look out for? (4)

* Tenderness (note the areas involved and the severity of the pain) * Rebound tenderness * Guarding * Masses

What are the nine regions of the abdomen that needs to be palpated?

* Right hypochondrium * Epigastrium * Left hypochondrium * Right flank * Umbilicus * Left flank * Right iliac fossa (RIF) * Hypogastrium * Left iliac fossa (LIF)

When carrying out deep palpation of the abdomen, if a mass is found what aspects need to be assessed? (6)

* Location (which region) * Size * Shape * Consistency - smooth / soft / hard / irregular * Mobility - is it attached to superficial / underlying tissue? * Pulsatility - a pulsatile mass suggest vascular aetiology

If the you feel the liver edge when palpating for the liver, what should be noted?

* Degree of extension below the costal margin * Consistency of the liver edge * Tenderness - suggestive of hepatitis * Pulsatility - a pulsatile enlarged liver can be caused by tricuspid regurgitation

What does an palpable (enlarged) gallbladder suggest?

• obstruction to the biliary flow / infection (cholecystitis0

What is murphy's sign?

* Palpate at the right costal margin, mid-clavicular line. * Ask the patient to take a deep breath * As the gallbladder is pushed down into your the patient may suddenly develop pain and stop inspiring. * A positive Murphy's sign is suggestive of cholecystitis

How enlarged does the spleen have to become until it is palpable?

• 3x

When auscultating the bowel what may be heard? (3)

* Gurgling = normal * Tinkling = abnormal - bowel obstruction * Absent - ileus / peritonitis

Where do you need to listen to bruits? (2)

* Aortic bruits - auscultate just above the umbilicus - AAA | * Renal bruits - auscultate just above the umbilicus, slightly lateral to the midline

To complete the abdominal examination what further investigations would you carry out? (3)

* Check hernial orifices - e.g. if there is sign of obstruction * Perform a digital rectal examination (PR) - e.g. if there is suggestion of an upper GI bleed * Perform an examination of the external genitalia - if appropriate