Examination

Question 1

Exam position?

Answer 1

peritonitis patients lie completely still,

severe pancreatitis patients sit forwards or lie in the recovery position.

Question 2

Exam jaundice?

Answer 2

seen with post-hepatic causes of biliary obstruction such as ascending cholangitis and gallstone induced acute pancreatitis, or with acute hepatitis.

Acute pancreatitis can also cause jaundice as pancreas can compress CBD

Question 3

Exam cullens of Grey-Turners?

Answer 3

acute haemorrhagic pancreatitis.

Question 4

Exam signs of small bowel obstruction?

Answer 4

distended abdomen and absent/tinkling bowel sounds

Question 5

Exam tenderness and guarding?

Answer 5

localised tenderness can be acute cholecystitis or mild pancreatitis.

If tenderness is severe = peritonitis.

Question 6

Exam masses?

Answer 6

Central, laterally expansile, pulsatile mass (AAA).

Check inguinal folds and femoral canal for hernias which may be causing bowel obstruction

Question 7

Exam respiratory exam?

Answer 7

check lung bases, check for signs of consolidation including decreased expansion, dullness to percussion, decreased breath sounds and increased vocal resonance