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MD3002 Clinical > Clinical Examination of the abdomen > Flashcards

Clinical Examination of the abdomen Flashcards

1
Q

What are the basic principles of a abdominal examination?

A
  • Intro and explanation
  • Inspection
  • Palpatation
  • Percussion
  • Auscultation
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2
Q

What things should you always remeber before starting the examination?

A
  • Introduce yourself
  • Check patient’s name and date of birth
  • Clean hands and stethoscope
  • Explain the examination and obtain consent
  • Check if the patient is in any pain or discumfort
  • Position the patient appropriately
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3
Q

What is cachexia

A

Weakness and wasting of the body due to chronic illness

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4
Q

What are the GI causes of clubbing?

A 
MILC 
- Malabsorption 
- IBD (UC + Crohn's)
- Lymphoma 
- Cirrhosis 
Remember CV and Resp causes
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5
Q

What can cause Asterixis (coarse flapping tremor)?

A

Occurs with hepatic encephalopathy

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6
Q

What is leuconychia?

A
  • Minor trauma to nails

- Sign of low albumin (liver disease)

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7
Q

What is koilonychia?

A
  • Spoon shaped nails
  • Iron deficiency anaemia
  • Can sometimes be a result of GI bleeding
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8
Q

What is palmar erythema?

A
  • Caused by high estrogen

- chronic liver disease

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9
Q

What is dupuytrens contraction?

A
  • Tendons in palm of hand become thickened
  • Unable to stretch out fingers
  • Associated with chronic liver disease
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10
Q

What is Spider Naevus?

A
  • Superficial blood vessels
  • High estrogen
  • Chronic liver disease / cirrhosis
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11
Q

What causes purpura?

A
  • Rash that dont blanch
  • Low platelets
  • Meningitis
  • Chronic liver disease
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12
Q

What causes jaundice?

A
  • High bilirubin

- Liver disease

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13
Q

What is usually the cause of painless jaundice?

A

Cancer of the head of pancreas

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14
Q

What does anaemia appear like?

A
  • Whitened inside lid of the eye
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15
Q

What is glositis?

A
  • Large inflammed tongue
  • ‘Beefy tongue’
  • B12 deficiency
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16
Q

What is oral candidiasis?

A
  • Oral thrush

- Caused by steroids often

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17
Q

What is angular stomatitis?

A

Cracked sides of lips - often dehydration

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18
Q

What is Peutz-Jegers syndrome?

A
  • Causes discoloration of lips
  • associated with polups and bowel cancer
  • Genetic
19
Q

What is telangiectasia?

A
  • Associated with low platetelets chronic liver dosease

- Spidery like veins / threads on lips

20
Q

What should you look for on the chest?

A
  • Spider naevi
  • Gynaecomastia (steroid abuse/overuse)
  • Loss of hair
  • Movement
  • Distention
  • Scars
  • Herniae
  • Masses
  • Striae
  • Dilated veins ‘caput medusae’
21
Q

What are the 5 main causes of distention of the abdomen?

A

5 Fs

  • Fat
  • Fuid - acites
  • Faeces - constipation
  • Flatus - gas/bowel obstruction
  • Foetus
22
Q

What should abdominal palpatation include?

A
  • Insure hands are warm
  • Kneel beside the bed
  • Ask patient to point to painful areas
  • Palpate 9 regions
    Superficial and deep palpatation
  • Watch the patients face
23
Q

What should you be palpating for?

A
  • Tenderness (including guarding or re-bound tenderness) / masses / organomegaly (liver, spleen, kidneys) / abdominal aorta
24
Q

How should you assess for hepatomegaly?

A
  • Liver moves with respiration
  • Begin in right iliac fossa
  • Ask patient to breathe 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
25
What sort of things should you include after finding hepatomegaly / what else should you look for?
- Size - Surface + edge (smooth/irregular) - Consistency (soft/hard) - Tenderness - Pulsatility
26
What are the causes of hepatomegaly?
- Hepatitis - Alcoholic liver disease - Right HF - Farry infiltration - Biliary tract obstruction - Malignancy (metastatic / primary) - Haematological disorders
27
What is Murphy's sign?
- Acute cholecystitis - Feel for gall bladder tenderness - Patient breathes in whilst you gently palpate RUQ in mid-clavic line - On liver descent contact with inflamed gallbladder causes tenderness and sudden arrest of inspiration
28
What is Courvoisier's sign?
- Painless jaundice and a palpable gallbladder - Likely due to extrahepatic obstruction - e.g pancreatic cancer - UNLIKELY to be gallstones
29
How do you palpate the bladder?
- Palpate upper border - In midline - Lower border not palpable
30
How do you palpate tthe kidneys?
- Ballot kidneys | - Remember to sit patient forwards and palpate for renal r=tenderness when examining back later
31
What does an expansile abdominal mass usually mean?
Abdominal aortic aneurysm
32
How do you percuss the liver?
- Percuss up to right costal margin for lower border of liver - Percuss downwards from just above right nipple for upper border of liver
33
How do you percuss the bladder?
From umbilicus down in midlne
34
How do you percuss the spleen?
Percuss towards left hypocondium for lower border of spleen
35
How do you percuss to look for ascites?
- Start in mid-line - Percuss towards flanks - Shifting dullness and fluid thrill
36
What are the causes of ascites?
- Hepatic cirrhosis - Intra-abdominal malignancy - Nephrotic syndrome - Cardiac failure - Pancreatitis - Constrictive pericarditis
37
What can enlarged cervical lymph nodes indicate?
- May indicate local disease | - Tumours of the upper GI tract may metastasise here
38
What other examinations should ypu offer to do?
- Groin - Genitalia - Digital Rectal Examination
39
What can indicate a rectal examination?
- Rectal bleeding - Prostatic symptoms - Change in bowel habit - Possible spinal cord injury
40
What pathologies could you find upon PR examination?
- Haemorrhoids - Rectal prolapse - Anal fissure - Skin tags - Anal carcinoma - Prostatic enlargement - Benign prostatic hyperplasia - Prostatic carcinoma - Prostatitis (tender prostate)
41
What can indicate a female reproductive examination?
- Pelvic pain - Abnormal vaginal bleeding - Abnormal vaginal discharge - If considering vaginal or uterine prolapse
42
Name some female pelvic pathologies?
- Ovarian pathology cyst, malignancy - Uterine pathology prolapse, fibroids, cervical carcinoma, carcinoma of body of uterus - Vaginitis, vaginal prolapse - Pelvic infection (pelvic inflammatory disease) - Ectopic pregnancy - do a test
43
What should you look for in a male reproductive examination?
- Infection (epididymitis, orchitis, epididmyo-orchitis) - Testicular torsion - Epididymal cysts - Testicular tumours - Indirect inguinal hernia

MD3002 Clinical (4 decks)

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