Clinical Examination of Abdomen/GU Flashcards
What are the red flags for testicular cancer?
hard, discrete and claggy lumps (tending to form clots, sticky?)
What is a red flag for endometrial carcinomas?
post-menopausal bleeding
What indicates possible pancreatic cancer?
- painless jaundice
- fatty stools
(signifies non-functioning pancreatic enzymes)
What are the GI causes of finger clubbing?
MILC
- malabsorption
- inflammatory bowel disease
- lymphoma
- cirrhosis
What is asterixis and what is this a sign of?
- course flapping tremor
- sign of hepatic encephalopathy
What is leuconychia?
white discolouration on the nail beds
What are some potential findings on close inspection of the hands?
- palmar erythema (sign of cirrhosis/liver disease)
- dupuytrens contracture (alcohol excess)
- spider naevus (liver disease esp if many)
- purpura (low platelets associated with liver dysfunction)
What are some potential findings on inspection of the face and mouth?
- jaundice (yellowing of skin or sclera due to excess bilirubin)
- pale conjunctiva
- stomatitis (inflammation of mucous membranes of lips and mouth)
- glossitis (inflammation of tongue)
- candidiasis (yeast infection, yellow on top of tongue)
- telangiectasia (spider veins, can be sun damage related)
- gingivitis
What are things than can be spotted on inspection of the chest and axilla?
- spider naevi
- gynaecomastia
- loss of axillary hair
What should you think of if you notice your patient’s abdomen is distended?
5 F’s
- fat
- fluid
- faeces
- foetus
What are you palpating for when feeling the stomach?
- tenderness:
- guarding: upon pressure
- rebound: after removal of pressure
- masses
- organomegaly
- abdominal aorta
- important to look at patient’s face
How do you palpate for hepatomegaly?
- liver descends with inspiration
- start at right iliac fossa and ask patient to breathe in and out deeply
- palpate upwards to right costal margin and feel for liver edge
What are the causes of hepatomegaly?
- hepatitis
- alcohol liver disease
- right heart failure
- fatty infiltration
- biliary tract obstruction
- malignancy
- haematological disorders
What is Murphy’s sign?
- method for feeling for gallbladder tenderness
- patient breathes whilst you palpate the RUQ mid clavicular 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
- likely due to extrahepatic obstruction (eg. pancreatic cancer)
How would you palpate for splenomegaly?
- spleen descends on inspiration
- ask patient to breathe in and out deeply and palpate upwards to left hypochondrium
- move hands between each breath
What are some causes of splenomegaly?
- haematological
- infective
- portal hypertension
- rheumatological disorders
- rare causes (sarcoidosis/amyloidosis/glycogen storage disease)
What are some causes of renal enlargement?
- hydronephrosis (swelling due to build up of urine)
- polycystic kidney disease
- renal cell carcinoma
- Wilm’s tumour
- solitary cysts
What are some causes of ascites?
- hepatic cirrhosis
- intra-abdo malignancy
- nephrotic syndrome
- pancreatitis
- constrictive pericarditis
What are the indications for a rectal examination?
- rectal bleeding
- prostatic symptoms
- change in bowel habits
- possible spinal cord injury
What is a bi-manual pelvic exam?
one hand palpates the vagina and the other the abdomen
What are some indications for a pelvic exam?
- pelvic pain
- abnormal vaginal bleeding or discharge
- possible vaginal or uterine prolapse
