**ACC (Y4)** Abdominal: Examination

Question 1

what should you do before starting an abdo examination?

Answer 1

• greet patient
• introduce self
• explain what you’re going to do and why (gain consent)
• clean hands

Question 2

during a general observation prior to an abdo examination, what would you be looking for?

Answer 2

• of patient (conscious level, colour, comfortable or in pain, general habitus)
• of bedside (catheter/IV fluids, ? Nil by mouth (NBM), PEG feed)

Question 3

what are GI causes of clubbing?

Answer 3

cirrhosis
ulcerative colitis
Crohn’s disease
coeliac disease

Question 4

with reference to abdo examination what is Asterixis and what does it indicate?

Answer 4

Asterixis is a tremor of the hand when the wrist is extended (hepatic flap) - indicates liver failure

Question 5

what order would you conduct a abdo examination in

Answer 5

1. introduction
2. check hands (incl liver flap)
3. check pulse
4. check eyes (jaundice of sclera, Kayser-Fleischer rings, pale conjunctiva)
5. check face (pallor jaundice, telangiectasia)
6. check mouth (ulcers, glossitis, candidiasis, angular stomatitis) note smell of breath (ketosis, uraemia)
7. palpate lymph nodes (virchow’s node suggestive of gastric cancer)
8. inspection. of abdomen (scars, symmetry, shape, bruising, spider naevi).
9. palpate abdomen (remember to ask if any pain first).
10. repeat deep palpation of abdomen.
11. percussion (liver, spleen and bladder, shifting dullness and fluid thrill)
12. Ausculation (bowel sounds or renal bruits)

Question 6

with reference to an abdominal examination, what may rebound tenderness indicate?

Answer 6

peritonitis

Question 7

with reference to an abdominal examination, what is involuntary guarding?

Answer 7

involuntary guarding where the intra-abdominal pathology has progressed to cause rigidity of the abdominal muscles that the patient can not relax.

Question 8

what end pieces may you add on to an abdominal examination in an once?

Answer 8

• examine for hernia
• examine external genitalia
• PR exam
• temperature
• urinalysis (+pregnancy test)
• stool sample

Question 9

During an abdominal examination, what are you looking for on inspection of the abdomen?

Answer 9

• scars
• symmetry
• shape
• lumps
• distention
• peristalsis or pulsation
• venous distention
• discolouration
• spider naevi

Question 10

During an abdominal examination, what are you looking for during palpitation of the abdomen?

Answer 10

• tenderness
• involuntary guarding
• rebound tenderness
• organomegaly: liver, spleen, kidneys, bladder and aorta.

Question 11

During an abdominal examination, what are you looking for during auscultation?

Answer 11

• bowel sounds
• bruits
• renal / aortic bruits

Question 12

During an abdominal examination, what are you looking for during an inspection of the hands and nails?

Answer 12

• Leuconychia, koilonychia,
• Clubbing
• Palmar erythema, pale palmar creases, spider naevi, Dupytren’s contracture
• Check for a hepatic flap
• Pulse check