Clinical Examination Flashcards
What is Palmar erythema?
Palms of hands red - may feel slightly warm.
What is petechiae?
Small red or purple spot on the skin. Caused by a minor bleed from broken capillary blood vessels.
What are spider naevi?
Dilated blood vessels seen under the skin.
What is jaundiced?
Yellowish discolouration of the skin - due to hyperbilirubin
What is dysphagia?
Difficulty swallowing. Neurological or Mechanical
What is odynophagia?
Pain on swallowing, often from hot liquids.
What is Virchow’s node?
Lymph node in left supraclavicular fossa. Common site of distant lymph node metastasis.
What is Haematemesis?
Vomiting of blood.
What is Melaena?
Passage of tarry, shiny black stools with odour. Results from upper GI bleed.
What is Haematochezia?
Passage of fresh blood through the anus, usually in or with stools.
What is guarding?
Tensing of abdominal wall muscle - guard inflamed organs, within abdomen.
What is ascites?
Abnormal accumulation of fluid in the abdomen (cirrhosis of liver)
What is Flatus?
Gas in or from stomach or intestine produced by swallowing air or by bacterial fermentation.
What is Flatulence?
Accumulation of gas in alimentary canal.
What is a hernia?
An internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. Usually between chest and hips.
What is hepatomegaly?
Abnormal enlargement of liver
What is Splenomegaly?
Abnormal enlargement of spleen
If you find a abdominal mass what do you need to be able to describe?
Site Size Shape Surface (smooth/craggy) Edge/outline (regular/irregular) Tenderness to palpation Consistency (hard/soft) Mobility Pulsatile? Fluctuant? Is it possible to get above the mass?
Abdominal exam:
What do you look for in the hands?
Look at both hands and compare:
Tar staining
Nail colour - anaemia or leukonychia
Nail shape - clubbing (cirrhosis, IBD), koilonychia (iron deficiency anaemia)
Palms - Palmar erythema, pale palmar crease
Abdominal exam:
What do you look for the arms?
Bruising (liver dysfunction) Scratch marks/pruritus Muscle wasting Track marks (Hep B and C) Forearms for loss of skin turgor (dehydration)
Look for tremor: Flapping tremor (liver failure) Fine tremor (alcohol and withdrawal)
Pulse, Resp rate and BP.
Abdominal exam:
What do you look for in head, face, eyes,mouth?
And the necklace region?
Face = parotid swelling (alcohol)
Eyes = Jaundice, anaemia
Mouth = Angular stomatitis and sore red tongue, odour of footer hepaticus ( liver failure)
Necklace region = Spider naevi, gynaecomastia, loss of body hair in males.
Abdominal exam:
Lymph nodes?
Follow the full routine.
Scalene node on the left for Virchow’s node ( thoracic duct drains structures below diaphragm through this node)
Attend to anterior and posterior chain nodes (drains structures in neck)
Tonsillar - drains oropharynx
Submandibular - drains 2/3 tongue and floor of mouth
Submental - drains tip of tongue and anterior floor of mouth
Pre auricular - drains face including parotid.
Abdominal exam:
Legs?
Peripheral oedema (liver failure/ hypoalbuminaemia) Loss of body hair Erythema nodosum (IBD) (red sores on legs)
Abdominal exam:
Abdomen inspection
Patient lying supine: Scars Visible pulsation Movement with respiration Skin lesions Scratch marks (chronic cholestasis) Abdominal shape Stoma Distended veins Petechiae - pin-head sized red spots Striae (weight loss) Abdominal distension ( 5Fs - fat, faeces, flatus, fluid or foetus)
Abdominal exam:
Palpation
Always watch patients facial expression and ensure hands are as warm as possible.
Light palpation:
Palpation over the 9 regions:
- palpate for superficial masses, areas of tenderness, increased muscle tone (guarding) and rigidity.
Deep palpation over 9 regions:
Ask about firmness;
Areas of tenderness
May feel - Pulsation of abdominal aorta in epigastrium,
Caecum in right lower quadrant
Descending and sigmoid colon on the left side.
Liver edge in the right costal margin.
