Gastro Exam Flashcards
What is the importance of confusion in an abdominal exam?
- Feature of end-stage liver disease (hepatic encephalopathy)
What may abdominal distension indicate?
- Presence of ascites or underlying bowel obstruction and/or organomegaly
What is the relevance of pallor in a abdominal exam?
Underlying anaemia e.g. GI bleed or malnutrition
What may jaundice indicate?
- High bilirubin levels
- Acute hepatitis, liver cirrhosis, cholangitis, pancreatic cancer
Why might there be hyperpigmentation in an abdominal exam?
Associated with haemochromatosis
What is the relevance of oedema in an abdominal exam?
Associated with liver cirrhosis - impaired albumin production
What is cachexia?
Ongoing muscle loss that isn’t entirely reversed with nutritional supplementation
What is cachexia associated with?
- Underlying malignancy
- Advanced liver failure
What signs are there on the palms of the hands in a abdomen exam?
- Pallor
- Palmar erythema
- Dupuytren’s contracture
What is palmar erythema and what may it be seen in?
- A redness involving the heel of the palm
- Chronic liver disease
What is koilonychia?
Spoon-shaped nails, associated with iron deficiency anaemia
What is leukonychia?
Whitening of the nail bed, associated with hypoalbuminaemia
What is leukonychia seen in?
- End stage liver disease
- Protein-losing enteropathy
Why might clubbing be seen in a abdominal exam?
- IBD
- Coeliac disease
- Liver cirrhosis
- GI lymphoma
What is the causes of asterixis in an abdominal exam?
- Hepatic encephalopathy (due to hyperammonaemia)
- Uraemia secondary to renal failure
What should be completed on palpation of the hands in an abdominal exam?
- Temperature
- Radial pulse
- Dupuytren’s contracture
What is Dupuytren’s contracture?
Thickening of the palmar fascia
When may Dupuytren’s contracture be seen?
- Genetic
- Excessive alcohol use
- Increasing age
- Male
- Diabetes
What should be noted on inspection of the arms in an abdominal exam?
- Bruising (secondary to liver disease)
- Scratch marks (due to pruritus - cholestasis)
- Needle track marks (viral hepatitis)
What is Grey Turner’s sign?
- Brusing of the flank
- Predicts acute haemorrhage pancreatitis
What is Cullen’s sign?
Bruising of tissue surrounding the umbilicus associated with haemorrhagic pancreatitis
Why may acanthosis nigricans occur in an abdominal exam?
- Associated in insulin resistance
- GI malignancy e.g. stomach cancer
What is the relevance of axillary hair loss in an abdominal exam?
- Iron-deficiency anaemia
- Malnutrition
What is important to inspect in the eyes in an abdominal exam?
- Conjunctival pallor
- Jaundice
- Corneal arcus
- Xanthelasma
- Kayser-Fleischer rings
- Perilimbal injection
What is corneal arcus?
Hazy white/grey ring around cornea, indicates hypercholesterolaemia
What is xanthelasma?
Yellow cholesterol deposits around the eye - hypercholesterolaemia
What are Kayser-Fleischer rings associated with?
Wilson’s disease - may also cause liver cirrhosis
What is perilimbal injection?
- Inflammation of the area of conjunctiva
- Sign of anterior uveitis
- Associated with IBD
What should be inspected for in the mouth in an abdominal exam?
- Angular stomatitis
- Glossitis
- Oral candidiasis
- Aphthous ulceration
- Hyperpigmentated macules
What is angular stomatitis?
- Inflammatory condition affecting corners of the mouth
- Iron deficiency as cause
What is glossitis?
- Smooth erythematous enlargement of the tongue
- Associated with iron, B12 and folate deficiency
- Secondary to IBD
What may cause aphthous ulceration?
- Iron, B12, folate deficiency
- Crohn’s disease
What may hyperpigmentated macules indicate?
- Peutz-Jeghers syndrome, which leads to polyp development
What may enlargement of Virchow’s node indicate?
- Metastatic intra-abdominal malignancy
- On the left side of the patient
What are spider naevi and what do they indicate?
- Skin lesions that have a central red papule with fine red lines
- Usually associated with liver cirrhosis
What is the relevance of gynaecomastia in a abdominal exam?
- May be caused by increased oestrogen, indicating liver cirrhosis
What are the 6 f’s of abdominal distension?
- Fat
- Fluid
- Flatus
- Faeces
- Fetus
- Fulimant mass
What is caput medusae and what is it associated with?
- Large periumbilical veins associated with portal hypertension
- Associated with liver cirrhosis
What is rebound tenderness?
- Slow compression of the abdomen and quick release
- Results in sudden sharp abdominal pain
- Associated with peritonitis e.g. appendicitis
What is guarding?
- Involuntary tension in abdo muscles on palpation
- Associated with peritonitis e.g. appendicitis, diverticulitis
What is Rovsing’s sign?
- Palpation of the left iliac fossa causes pain in the right iliac fossa
- Suggestive of peritonitis
What may pulsatility of palpation mean in an abdominal exam?
Suggestive of vascular aetiology e.g. AAA
What does it mean if the degree of extension below the costal margin of the liver is greater than 2cm?
Hepatomegaly
What does a nodular consistency of the liver indicate in a liver exam?
Cirrhosis
What does hepatic tenderness indicate?
- Hepatitis
- Cholecystitis
What is pulsatile hepatomegaly associated with?
Tricuspid regurgitation
Name 6 causes of hepatomegaly
- Hepatitis
- Hepatocellular carcinoma
- Wilson’s/haemochromatosis
- Leukaemia/myeloma
- Tricuspid regurgitation
- Haemolytic anaemia
What may make the gallbladder palpable?
- Enlargement secondary to biliary flow obstruction
- Pancreatic malignancy, gallstones, cholecystitis
What is Murphy’s sign and what makes it positive?
- Ask patient to take deep breath while palpating
- If they stop mid-breath due to pain, it indicates cholecystitis
What does a distended painless gallbladder indicate?
Pancreatic cancer
Should the spleen be be able to be palpated?
NO!
Name 5 causes of splenomegaly
- Portal hypertension secondary to liver cirrhosis
- Haemolytic anaemia
- Congestive heart failure
- Splenic metastases
- Glandular fever
Name a cause for a bilaterally enlarged kidney
PKD or amyloidosis
Name a cause for a unilaterally enlarged kidney
Renal tumour
What is the healthy movement of the hands when palpating the abdominal aorta?
Should move superiorly
What does it mean when your hands move outwards when palpating the abdominal aorta?
An expansile mass e.g. abdominal aortic aneurysm
What may cause a distended bladder which could be palpated?
Urinary obstruction/retention
Should you be able to percuss the spleen normally?
No, it only should be when there is splenomegaly
What does shifting dullness show?
The presence of ascites. This is when the percussion goes from dull to resonant in the flank.
What is a normal bowel sound?
Gurgling
What does a tinkling bowel should show?
Bowel obstruction
What may cause absent bowel sounds?
An ileus (when there is a lack of movement in the bowels)
What bruits should be listened to in an abdominal exam?
- Aortic bruit
- Renal bruit
What may an aortic bruit be associated with?
Abdominal aortic aneurysm
What may a renal bruit be associated with?
Renal artery stenosis
What may pitting oedema indicate in an abdominal exam?
- Hypoalbuminaemia, so liver cirrhosis or protein-losing enteropathy
What should be completed at the end of an abdominal exam?
- Hernial orificies check
- DRE
- External genitalia examination
