Clinical Flashcards
What is hepatic encephalopathy?
A spectrum of neurological abnormalities in patients with liver dysfunction, e.g. personality changes, intellectual impairment, depressed level of consciousness
What should you look for when examining the hands, and what do the signs mean?
Koilonychia (abnormally thin/flat nails) - anaemia
Leuconychia (white spots on nails) - micronutrient deficiencies
Clubbing - IBS, Crohn’s, cirrhosis
Tar staining
Muscle wasting
Pallor of palmar creases - anaemia
Palmar erythema - liver problems
Dupuytren’s contracture (thickening of fascia on palms) - liver problems, alcohol
What should you look for when examining the arms and what do the signs mean?
Bruising - possibly due to liver dysfunction
Scratch marks - chronic cholestasis (excess bilirubin can make the skin itchy)
Muscle wasting - inadequate nutrition, sepsis
Track marks - IVDU (risk of hep B/C)
Loss of skin turgor - dehydration
Give two types of tremor and what they indicate (in the context of GI problems)
Fine tremor - alcohol (withdrawal), delirium tremens
Flapping tremor - liver failure
What should you look for when examining the eyes and what do the signs mean?
Conjunctival pallor - anaemia
Jaundiced sclera
What should you look for when examining the mouth and what do the signs mean?
Buccal pigmentation
Swollen and/or bleeding gums
Tongue ulceration or abnormal smoothness
Angular stomatitis - Fe deficiency anaemia
What should you look for when examining the necklace region of the chest?
Spider naevi
Gynaecomastia
Distended veins
Hairless chest (males)
How might a patient appear in end of bed examination if they have abdominal pain?
Movement of abdomen with respiration may be shallow or absent with severe pain
Patient may be restless, or may be staying really still in the most comfortable position
What should you look for when inspecting the abdomen and what do the signs mean?
Abdominal scars - surgery, trauma
Stoma - ileostomy, colostomy
Shape: distended, localised swelling, mass
Distended veins - portal hypertension, IVC obstruction
Striae - weight loss
Jaundice
Scratch marks - chronic cholestasis, liver failure
Petichiae (bleeding under the skin) - possible liver dysfunction
Spider naevi, Campbell de Morgan spots
What should you look for during light palpation of the abdomen?
Superficial masses (abdominal wall)
Areas of tenderness - may be caused by inflammation of the parietal peritoneum
Guarding - increased muscle tension due to muscle contraction in response to pain (may also be caused by anxiety)
During deep palpation of the abdomen, what would you expect to feel in a “normal” patient?
Pulsation of abdominal aorta
Caecal squelch in right lower quadrant
Desending/sigmoid colon (may contain faeces) on the left side of the abdomen
Edge of liver in right costal margin
What abnormalities/signs of disease do you look for during deep palpation of the abdomen?
Abdominal masses
Areas of tenderness or pain
Where are the kidneys?
T12 - L3
Kidneys lie in the renal angle formed by the 12th rib and vertebral column
What should you listen for when auscultating the abdomen, and what do the signs mean?
Bowel sounds - only report absent if none are heard for at least 2 minutes in any area
- absence of bowel sounds indicates complete lack of peristalsis in the bowel (ileus)
High pitched “tinkling” may indicate bowel obstruction
Arterial bruits - abdominal aorta and renal arteries - indicate stenosis
Hepatic and/or splenic rubs - indicates inflammation of capsule (capsule makes a sound when it rubs against the peritoneum)
Which clinical signs may be present in a patient with liver cirrhosis?
Jaundice Scratch marks secondary to pruritus Spider naevi Skin telangiectasias (called 'paper money skin') Palmar erythema Bruising (may indicate reduced clotting factors) Petechiae, Purpura Hair loss Leuconychia Finger clubbing Dupuytren's contracture Hepatomegaly Gynaecomastia, hair loss in males (chest) Flapping tremor
