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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
Q

What sort of things should you include after finding hepatomegaly / what else should you look for?

A
  • Size
  • Surface + edge (smooth/irregular)
  • Consistency (soft/hard)
  • Tenderness
  • Pulsatility
26
Q

What are the causes of hepatomegaly?

A
  • Hepatitis
  • Alcoholic liver disease
  • Right HF
  • Farry infiltration
  • Biliary tract obstruction
  • Malignancy (metastatic / primary)
  • Haematological disorders
27
Q

What is Murphy’s sign?

A
  • 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
Q

What is Courvoisier’s sign?

A
  • Painless jaundice and a palpable gallbladder
  • Likely due to extrahepatic obstruction
  • e.g pancreatic cancer
  • UNLIKELY to be gallstones
29
Q

How do you palpate the bladder?

A
  • Palpate upper border
  • In midline
  • Lower border not palpable
30
Q

How do you palpate tthe kidneys?

A
  • Ballot kidneys

- Remember to sit patient forwards and palpate for renal r=tenderness when examining back later

31
Q

What does an expansile abdominal mass usually mean?

A

Abdominal aortic aneurysm

32
Q

How do you percuss the liver?

A
  • Percuss up to right costal margin for lower border of liver
  • Percuss downwards from just above right nipple for upper border of liver
33
Q

How do you percuss the bladder?

A

From umbilicus down in midlne

34
Q

How do you percuss the spleen?

A

Percuss towards left hypocondium for lower border of spleen

35
Q

How do you percuss to look for ascites?

A
  • Start in mid-line
  • Percuss towards flanks
  • Shifting dullness and fluid thrill
36
Q

What are the causes of ascites?

A
  • Hepatic cirrhosis
  • Intra-abdominal malignancy
  • Nephrotic syndrome
  • Cardiac failure
  • Pancreatitis
  • Constrictive pericarditis
37
Q

What can enlarged cervical lymph nodes indicate?

A
  • May indicate local disease

- Tumours of the upper GI tract may metastasise here

38
Q

What other examinations should ypu offer to do?

A
  • Groin
  • Genitalia
  • Digital Rectal Examination
39
Q

What can indicate a rectal examination?

A
  • Rectal bleeding
  • Prostatic symptoms
  • Change in bowel habit
  • Possible spinal cord injury
40
Q

What pathologies could you find upon PR examination?

A
  • Haemorrhoids
  • Rectal prolapse
  • Anal fissure
  • Skin tags
  • Anal carcinoma
  • Prostatic enlargement
  • Benign prostatic hyperplasia
  • Prostatic carcinoma
  • Prostatitis (tender prostate)
41
Q

What can indicate a female reproductive examination?

A
  • Pelvic pain
  • Abnormal vaginal bleeding
  • Abnormal vaginal discharge
  • If considering vaginal or uterine prolapse
42
Q

Name some female pelvic pathologies?

A
  • 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
Q

What should you look for in a male reproductive examination?

A
  • Infection (epididymitis, orchitis, epididmyo-orchitis)
  • Testicular torsion
  • Epididymal cysts
  • Testicular tumours
  • Indirect inguinal hernia

MD3002 Clinical (4 decks)

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