Clinical Examination: Abdomen and GU System Flashcards
What are the main principles of examiantion?
- Introduction and explanation
- Inspection
- Palpation
- Percussion
- Auscultation
What must you always establish before starting an examination?
if the patient is in any pain or discomfort
How should the patient be positioned for the examination of the abdomen and GU system?
- Comfortably supine with head resting on only 1 or 2 pillows
- Expose abdomen from xiphisternum to symphysis pubis
General Inspection:
What to look for when looking around the patient?
- Sick bowls
- Empty bottles/cans
General inspection:
What to look for when looking at the patient
- Does the patient look well or not?
- In pain?
- Nutritional state; cachectic or obese?
- Signs of liver disease e.g. bruising, spider naevi
- Oedema (GI/GU causes = cirrhosis, pelvic mass, nephrotic syndrome, renal failure)
What are the GI/GU causes of oedema?
hosis, pelvic mass, nephrotic syndrome, renal failure
What are the main GI causes of finger clubbing?
- Malabsorption (e.g. coeliac)
- Inflammatory bowel disease (UC + Crohn’s)
- Lymphoma
- Cirrhosis
What are the main GI causes of asterixis? (coarse flapping tremour)
hepatic encephalopathy (build up of toxins in the liver)
Leukonychia
- white deposits indicating low albumin
Koilonychia
- iron deficiency and potential GI tract bleeding
Palmer erytherma
- indication of chronic liver diease (high oestrogen levels)
Duputuyrens Contracture
- thickening of tendons in the fingers
- Associated with chronic liver disease and alcoholism
Spider Naevus
- superifical blood vessels
- increase oestrogen
- follow the path of the SVC (upper part of the body)
Purpura
- Rash that temains even when pressure is applied (non blanching)
- low platelets
- chronic liver disease
Jaundice and anaemia
What possibilities should you look for in the patients mouth?
Stomatitis, glossitis, candidiasis, ulcers, pigmentation (Peutz-Jeghers syndrome – very rare), telangiectasias, dentition, gingivitis and “mousy” odour (fetor hepaticus)
What should the chest be inspected for?
Inspect chest for spider naevi, gynaecomastia in men, and both axillae for loss of axillary body hair
What to look for in close inspection of the abdomen?
- Movement, distension, scars, herniae, masses, striae, dilated veins “Caput medusae)
- Distention
- Fat, fluid, faeces, flatus, foetus (“5 Fs”)
- Remember the abdomen is divided into 9 regions (or quadrants)
What should you palpate for in the abdominal examination?
Tenderness (including guarding or re-bound tenderness)/ masses/organomegaly (spleen, liver, kidneys)/abdominal aorta
How to palpate for liver hepatomegaly
- Begin in right iliac fossa
- Ask the patient to breath in and out deeply
- Palpate upwards to right costal margin
- Feel for liver edge as it descends on inspiration and move hand between each breath
Potential causes of hepatomegaly
- Hepatitis
- Alcoholic liver disease
- Right heart failure
- Fatty infiltration
- Biliary tract obstruction
- Malignancy (metastatic/primary)
- Haematological disorders
How to test for Murphy’s sign
- Feel for gall bladder tenderness (e.g. acute cholecystitis)
- Patient breaths in while you gently palpate RUQ in mid clavicular line
- On liver descent contact with inflamed gallbladder causes tenderness and sudden arrest of inspiration
How to feel for courcoisier’s sign
- Painless jaundice and a palpable gallbladder
- Likely due to extrahepatic obstruction
- E.g. Pancreatic Cancer
- UNLIKELY to be gallstones
Potential causes of splenomegaly
- Haematological – haemolytic anaemias / leukaemia’s / polycythaemia ruba vera / lymphoma/ myeloproliferative disease / myelofibrosis
- Infection – infective mononucleosis / infective endocarditis / TB / malaria
- Portal hypertension
- Rheumatological disorders – rheumatoid arthritis (Felty’s syndrome / SLE
- Rare causes – sarcoidosis / amyloidosis / glycogen storage diseases
