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MD3002 > Clinical Examination of the Abdomen/GU > Flashcards

Clinical Examination of the Abdomen/GU Flashcards

1
Q

What are the main steps of clinical examination ?

A

1) Inspection (including general inspection, and close inspection)
2) Palpation
3) Percussion
4) Auscultation

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2
Q

What position should the patient be in fora abdominal examination, and how much of the patient should be exposed ?

A

Patient supine with head resting on 1 or 2 pillows

Expose abdomen from xiphisternum to symphysis pubis

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3
Q

Identify the main features of general inspection in abdominal exam.

A

1) Look around patient
- Sick bowls
- Empty bottles/cans

2) Look at patient
- Look well or not ?
- In pain ?
- Nutritional state; cachectic or obese ?
- Signs of liver disease (bruising, spider naevi)
- Oedema

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4
Q

Define cachexia.

A

Loss of weight, muscle atrophy, fatigue, weakness

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5
Q

Identify GI/GU causes of oedema.

A

Cirrhosis, pelvic mass, nephrotic syndrome, renal failure

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6
Q

What parts of the body are included in close examination (in abdominal/GU examination) ?

A 
Face
Hands and arms
Mouth
Chest and axillae
Abdomen
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7
Q

Identify and define possible findings in close examination of the hands and arms (in GU/GI clinical exam).

A

1) Finger clubbing (+180 degree angle, normally 160)
2) Asterixis (coarse flapping tremor)
3) Leuconychia (white spots or streaks underneath nails)
4) Koilonychia (outer surface is concave)
5) Palmar eythema (inflammatory redness of the palms of the hands)
6) Dupuytrens contracture (painless thickening and tightening of subcutaneous tissue of the palm)
7) Spider Naevus (small, flat, red skin lesion caused by localized telangiectasia)
8) Purpura (a small hemorrhage in the skin or mucous membrane)

At this point, may also check for BP/temperature and radial pulse.

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8
Q

Identify GI causes of finger clubbing.

A

MILC:

Malabsorption
Inflammatory Bowel Disease (UC + Crohn’s)
Lymphoma
Cirrhosis

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9
Q

What is the cause of asterixis ?

A

Hepatic encephalopathy

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10
Q

What GI/GU condition is leuconychia associated with ?

A

Liver disease

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11
Q

What GI/GU condition is koilonychia associated with ?

A

Hyperchromic anaemia

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12
Q

What GI/GU condition is palmar erythema associated with ?

A

Liver failure (symptom appears due to high circulating levels of estrogen)

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13
Q

What GI/GU condition is Dupuytrens contracture associated with ?

A

Liver disease

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14
Q

What GI/GU condition is purpura contracture associated with ?

A

Conditions affecting platelet count e.g. splenomegaly (collects platelets in spleen, less in circulation)

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15
Q

What GI/GU condition is spider naevus associated with ?

A

Liver disease

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16
Q

Identify and define possible findings in close examination of the face (in abdominal/GU clinical exam).

A
  • Jaundice (person’s skin and the whites of the eyes are discolored yellow)
  • Anemic eyes (not pink)
  • Telangiectasia (chronic dilation of groups of capillaries causing elevated dark red blotches on the skin)
  • Peutz- Jegers Syndrome (brown deposits on the lips due to increase melanin)
  • Glossitis (inflammation of the tongue)
  • Angular stomatitis (superficial erosions at the angles of the mouth)
  • Oral Candidiasis
  • Mouth ulcers
  • Fetor hepaticus (foul-smelling breath associated with severe liver disease)
  • Gingivitis (inflammation of the gums)
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17
Q

What tools should we use for close inspection of the face ?

A

Tongue depressor, light (for mouth)

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18
Q

What GU/GI disease is glossitis associated with ?

A

B12 deficiency aneamia

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19
Q

What GU/GI disease are mouth ulcers associated with ?

A

Inflammatory Bowel Disease

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20
Q

What GU/GI disease are angular stomatitis associated with ?

A

Anaemia

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21
Q

What GU/GI disease is Peutz- Jegers Syndrome associated with ?

A

Multiple GI polyps, which increases the risk of bowel cancer

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22
Q

What GU/GI disease is Telangiectasia associated with ?

A

Liver disease

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23
Q

What GU/GI disease is Fetor Hepaticus associated with ?

A

Liver failure

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24
Q

What GU/GI disease is jaundice associated with ?

A

Liver disease (resulting in increased levels of bile pigments in the blood)

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25
Q

Identify and define possible findings in close examination of the chest and axillae (in GU/GI clinical exam).

A
  • Gynaecomastia (in men)= excessive development of the male mammary glands
  • Spider naevi
  • Loss of axillary body hair
26
Q

What GU/GI condition is Gynaecomastia associated with ?

A

Liver failure (not metabolising estrogen, high circulating levels of estrogen)

27
Q

What GU/GI condition is loss of axillary body hair associated with ?

A

Liver failure (not metabolising estrogen, high circulating levels of estrogen)

28
Q

Identify and define possible findings in close examination of the abdomen (in GU/GI clinical exam).

A 
Movement
Distension 
Scars
Herniae
Masses
Striae (stretch marks)
Caput medusae
29
Q

What GU/GI condition is caput medusae associated with ?

A

Portal hypertension with liver disease

30
Q

What are potential reasons for abdominal distension ?

A

Fat, fluid (ascites), feces, flatus, fetus

31
Q

Identify the main principles of abdominal palpation.

A
  • Ask patient to point to painful areas
  • Palpate all 9 regions (superficial then deep)
  • Watch patient’s face
32
Q

What are you looking for in abdominal palpation ?

A
  • Tenderness (including guarding or re-bound tenderness)
  • Organomegaly (liver, spleen, kidneys)
  • Abdominal aorta
  • Masses
33
Q

Describe how to palpate the liver for hepatomegaly.

A
  • The liver moves with respiration
  • Begin in the right iliac fossa
  • Ask 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 (somebody without hepatomeglaly, won’t feel anything, lower border of liver just below the ribs, up to slightly below).
  • Can confirm that by percussing (liver dull to percussion when hepatomegaly)
34
Q

What features of a hepatomegaly would you need to describe ?

A
  • Size
  • Surface + edges (smooth/irregular
  • Consistency (soft/hard)
  • Tenderness
  • Pulsatility ?
35
Q

Identify potential causes of hepatomegaly.

A
  • Hepatitis
  • Fatty infiltration
  • Alcoholic liver failure
  • R heart failure
  • Biliary tract obstruction
  • Haematological disorders
  • Malignancy (metastatic/primary)
36
Q

Define Murphy’s sign.

A

Essentially, feeling for gall bladder tenderness (for acute cholecystitis)

Patient breathes in while you gently palpate RUQ in mid-clavicular line. Upon liver descent (in inspiration), contact with the gall bladder causes tenderness and sudden arrest of respiration.

37
Q

Define Courvoisier’s sign.

A

Painless jaundice + palpable gall bladder, likely due to extrahepatic obstruction (e.g. pancreatic cancer, unlikely to be gall stones)

38
Q

Explain how to feel for splenomegaly.

A
  • The spleen normally moves with respiration.
  • Ask patient to breath in and out deeply
  • Palpate upwards to L hypochondrium
  • Feel for an edge of an enlarged spleen as it descends on inspiration
  • Characteristic notch may be palpable
  • Move hand between each breath
39
Q

Identify possible causes of splenomegaly.

A
  • Haemotological disorders (lymphoma, haemolytic anaemia, leukaemia,
  • Portal hypertension
  • Rheumatological disorders - Rheumatoid arthritis (Felty’s Syndrome)/SLE
  • Infection (infective endocarditis, TB, malaria,
  • Others (sarcoidosis, amyloidosis, glycogen storage diseases)
40
Q

Describe the process of palpation of the bladder.

A

Palpable upper border
Below level of umbilicus
In midline
Lower border not palpable

41
Q

Describe the process of renal palpation.

A
  • Ballot kidneys (“place one hand under the patient in the flank region and the other hand on top just below the borders of the costal margin, push kidneys between the two hands”). Feel for enlargement of kidney.
  • Remember to sit patient forwards and palpate for renal tenderness when examining back later
42
Q

Identify potential causes of renal enlargement.

A
  • Hydronephrosis
  • Renal cell carcinoma
  • (In children) Nephorblastoma = Wilm’s tumour
  • Solitary cysts
  • Polycystic kidney disease
43
Q

Why is palpation of the abdominal aorta important ? How would you feel an abdominal aneurysm ?

A

Because it is the most common aortic aneurysm (large aneurysms may rupture), and this may be asymptomatic.

Feel expansile mass per abdomen.

44
Q

Describe how to percuss for the liver.

A

Percuss up to the right costal margin for the lower border of the liver.
Percuss downwards from just above right nipple for upper border of the liver.

45
Q

Describe how to percuss for the spleen.

A

Percuss towards L hypochondrium for lower border of the spleen.

46
Q

Describe how to percuss for the bladder.

A

Percuss from the umbilicus down in the midline for the bladder.

47
Q

Define ascites. How would you determine the presence of ascites in the clinical examination of the abdomen ?

A

Abnormal collection of fluid in the peritoneal cavity.

  • Start in the midline, then percuss towards the flanks (middle should still be resonant, since fluid collects in the flanks) which should be dull. Mark the separation of dullness and resonance and roll patient onto the side, test again for dullness and now the area of dullness (i.e. where fluid is) should have shifted due to gravity (i.e. shifting dullness)
  • May also feel fluid thrill (“transmitted pulsation due to movement of fluid”)
48
Q

Identify potential causes of ascites.

A
  • Nephrotic syndrome
  • Hepatic cirrhosis
  • Cardiac failure
  • Constrictive pericarditis
  • Pancreatitis
  • Intra-abdominal malignancy
49
Q

Identify the main steps in auscultation of the diaphragm.

A
  • Listen for normal bowel sounds (rupture would give no bowel sounds, obstructive lesion would give tinkling bowel sound)
  • Auscultate for turbulent blood flow (for bruits) (abdominal aorta, renal arteries, iliac arteries, femoral arteries)
50
Q

Identify the main steps in clinical examination of the back.

A

1) Sit patient forwards
2) Inspect back
3) Palpate for renal tenderness
4) Palpate for cervical lymph nodes

51
Q

What are potential causes for swelling or pain of cervical lymph nodes ?

A
  • Local disease
  • Tumours of the upper GI tract may metastasise to the lower part of the left posterior cervical triangle (causing enlarged left supraclavicular node AKA Virchow’s nodes, i.e. Troisier’s sign)
52
Q

What are other areas you should offer the examination of at the end of your abdominal examination ?

A
  • Groin
  • Genitalia (including female and male repro exams)
  • Requests to do digital rectal examination (DRE)
53
Q

Identify the main indications for rectal examinations.

A
  • Rectal bleeding
  • Prostatic symptoms
  • Change in bowel habits
  • Possible spinal cord injury
54
Q

True or false: you should offer a chaperons for rectal examinations.

A

TRUE

55
Q

Identify pathologies you can may discover in a PR examination (prostate exam/rectal exam)

A
  • Haemorrhoids
  • Anal fissures
  • Rectal prolapse
  • Skin tags
  • Anal carcinoma
  • Anal fistula
  • Prostatic enlargement
56
Q

Identify potential causes of prostatic enlargement.

A
  • Benign prostatic hyperplasia
  • Prostatic carcinoma
  • Prostatitis (tender prostate)
57
Q

Identify the main components of a female reproductive system exam.

A

Bi-manual pelvic examination (one hand palpates vagina and the other palpates abdomen)

Speculum examination (“inserted into the woman’s vagina. The speculum helps to spread apart the walls of the vagina, allowing the health professional to see the cervix and the walls of the vagina. Samples of tissue may also be collected for testing”)

58
Q

What are the main indication for a bimanual pelvic exam ?

A
  • Pelvic pain
  • Abnormal vaginal bleeding
  • Abnormal vaginal discharge
  • If considering vaginal or uterine prolapse
59
Q

Identify the main female pelvic pathologies.

A

1) Ovarian pathology (ovarian cyst, malignancy)
2) Uterine pathology (uterine prolapse, fibroids, cervical carcinoma, carcinoma of body of uterus)
3) Vaginal pathology (vaginitis, prolapse)
4) Pelvic infection (pelvic inflammatory disease)
5) Ectopic pregnancy (do pregnancy test, can be + for pregnancy)

60
Q

What testing is often used to detect female or male reproductive pathologies ?

A

Ultrasound scan

pelvic ultrasound scan for females

61
Q

Identify the main components of a male reproductive exam.

A

1) Testicular exam

62
Q

Identify the main male reproductive pathologies.

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

MD3002 (95 decks)

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