Clinical Examination of Abdomen/GU Flashcards
What are the red flags for testicular cancer?
Hard, discrete and claggy lumps
What is a red flag for endometrial carcinomas?
Post menopausal bleeding
What indicates a possible differential diagnosis of pancreatic cancer
Painless jaundice and fatty stools (non functioning pancreatic enzymes)
What are the GI causes of clubbing?
MILC; Malabsorption, Inflammatory bowel disease, Lymphoma, Cirrhosis
What is asterixis a sign of?
(course flapping tremor) which occurs with hepatic encephalopathy
What is leuconychia?
white discolouration on the nail beds
Name some potential findings upon close inspection of the hands
Palmar erythema - Potentially cirrhosis or liver disease.
Dupuytrens contracture - Alcohol excess.
Spider Naevus - potential liver disease,
Purpura - Low platelets associated with liver dysfunction
What are some potential findings on close inspection of the face and mouth
- Jaundice - Yellowing of skin or sclera due to excess bilirubin.
- Pale conjuntiva,
- Stomatitis,
- Glossitis,
- Candidiasis,
- telangiectasia (can be sun damage related),
- Gingivitis
What are you looking for when doing a close inspection of the chest and axilla?
Spider naevi, gynaecomastia and loss of axillary hair.
When examining the abdomen what should you think when it is distended?
5 F’s - Fat, fluid, faeces, flatus (gas) or foetus
When palpating the abdomen what are you palpating for?
Tenderness (guarding or re-bound tenderness), masses, organomegaly and abdo aorta. Make sure to watch the patients face.
How do you palpate for hepatomegaly?
- Liver moves with respiration, it descends with inspiration. Start at right iliac fossa and ask patient to breath in and out deeply. Palpate upwards to right costal margin and feel for liver edge.
What are some of the causes of hepatomegaly?
Hepatitis, alcohol liver disease, right heart failure, fatty infiltration, biliary tract obstruction, malignancy or haematological disorders
What is Murphy’s sign?
- Method of feeling for gall bladder tenderness. Patient breaths whilst palpation of RUQ, mid clavic line. On liver descent contact with inflamed gallbladder causes tenderness and sudden arrest of inspiration
What is Courvoisier’s sign?
- Painless jaundice and a palpable gallbladder which is likely due to extrahepatic obstruction eg, pancreatic cancer
How can you palpate for splenomegaly?
Spleen descends on inspiration, ask the patient to breath in and out deeply and palpate upwards to left hypochondrium. Move hands between each breath.
What are some of the causes of splenomegaly?
Haematological, infective, portal hypertension, rheumatological disorders and more rare causes eg, sarcoidosis, amyloidosis or glycogen storage disease
What are some of the causes of renal enlargement?
Hyponephrosis, polycystic kidney disease, renal cell carcinoma, wilm’s tumour or solitary cysts.
What are some causes of ascites?
Hepatic cirrhosis, intra-abdominal malignancy, nephrotic syndrome, pancreatitis and constrictive pericarditis etc
What are the indications for a rectal examination?
Rectal bleeding, prostatic symptoms, a change in bowel habits and a possible spinal cord injury
What is a bi-manual pelvic exam?
One hand palpates per vagina and the other per abdomen
What are some indications for a pelvic examination?
Pelvic pain, abnormal vaginal bleeding or discharge and if considering a vaginal or uterine prolapse
