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YEAR 4 - GASTROENTEROLOGY > Abdominal Examination (Geeky Medics) > Flashcards

Abdominal Examination (Geeky Medics) Flashcards

1
Q

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

A
  • feeding tubes
  • stoma bags
  • drains
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2
Q

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

A
  • in pain?
  • agitated?
  • confused?
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3
Q

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

A
  • obese?
  • low BMI?
  • cachetic?
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4
Q

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

A
  • midline scars - laparotomy
  • RIF - appendectomy
  • right subcostal - cholecystectomy
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5
Q

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)

A
  • 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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6
Q

What are the gastro causes of clubbing? (3)

A
  • inflammatory disease
  • cirrhosis
  • coeliac disease
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7
Q

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

A

• Koilonychia - chronic iron deficiency

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8
Q

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

A

• leukonychia - hypoalbuminemia - liver failure / enteropathy

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9
Q

What is a reddening of the palm called?

A

• Palmar erythema - liver disease / pregnancy

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10
Q

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

A
  • Thickening of the fascia

* Alcohol excess / family history

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11
Q

What can cause a hepatic flap? (3)

A
  • hepatic encephalopathy
  • uraemia
  • CO2 retention
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12
Q

What may bruising of the arm suggest?

A

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

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13
Q

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

A
  • a spotty red rash on the skin

* low platelets

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14
Q

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

A
  • A scratch mark

* cholestasis

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15
Q

What could tract marks indicate? (arm)

A
  • intravenous drug use

* hepatitis / HIV

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16
Q

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

A
  • Lymphadenopathy - malignancy / infection
  • Hair loss - malnourishment / iron deficiency anaemia
  • Acanthosis nigricans (darkened pigmentation) - GI adenocarcinomas / obesity
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17
Q

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

A
  • 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
18
Q

What does conjunctival pallor indicate?

A

• significant anaemia

19
Q

What is Xanthelasma and what does it indicate?

A
  • raised yellow deposits surrounding the eyes

* Primary biliary cirrhosis (PBC) / hyperlipidaemia

20
Q

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

A
  • Angular stomatitis

* iron/B12 deficiency

21
Q

What is oral candidiasis and what does it indicate?

A
  • white slough on oral mucous membranes

* iron deficiency / immunodeficiency

22
Q

What may mouth ulcers indicate?

A

• Crohn’s disease / coeliac disease

23
Q

What is glossitis and what might it indicate?

A
  • smooth swelling of the tongue with associated erythema

* iron/B12/folate deficiency

24
Q

What could large cervical lymph nodes indicate?

A
  • lymphadenopathy

* infection / metastatic malignancy

25
Q

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

A
  • Virchow’s node

* gastric malignancy

26
Q

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

A
  • central red spot with reddish extensions
  • chest
  • > 5
  • chronic liver disease
27
Q

What is gynaecomastia and what may it indicate?

A
  • overdevelopment of male mammary glands (pseudofeminisation)
  • liver cirrhosis / digoxin / spironolactone
28
Q

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

A

•pseudofeminisation / malnourishment / iron deficiency

29
Q

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

A
  • 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)
30
Q

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

A
  • peritonitis

* pain is worsened on releasing the pressure

31
Q

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

A

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

32
Q

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

A
  • Tenderness (note the areas involved and the severity of the pain)
  • Rebound tenderness
  • Guarding
  • Masses
33
Q

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

A
  • Right hypochondrium
  • Epigastrium
  • Left hypochondrium
  • Right flank
  • Umbilicus
  • Left flank
  • Right iliac fossa (RIF)
  • Hypogastrium
  • Left iliac fossa (LIF)
34
Q

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

A
  • 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
35
Q

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

A
  • 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
36
Q

What does an palpable (enlarged) gallbladder suggest?

A

• obstruction to the biliary flow / infection (cholecystitis0

37
Q

What is murphy’s sign?

A
  • 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
38
Q

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

A

• 3x

39
Q

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

A
  • Gurgling = normal
  • Tinkling = abnormal - bowel obstruction
  • Absent - ileus / peritonitis
40
Q

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

A
  • Aortic bruits - auscultate just above the umbilicus - AAA

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

41
Q

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

A
  • 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

YEAR 4 - GASTROENTEROLOGY (2 decks)

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