Head to toe- abdominal Flashcards
1
Q
End of bed examination- clinical signs
A
- Confusion- hepatic encephalopathy
- Pain
- Scarring
- Abdominal distension
- Pallor
- Jaundice
- Oedema
- Cachexia
- Hernia
2
Q
End of bed exam- equipment
A
- Stoma bags
- Surgical drains
- Feeding tubes
3
Q
Hands- palms
A
- pallor
- palmar erythema is associated with chronic liver disease
- Dupuytrens contracture- thickening of palmar fascia causing contracture deformities of fingers/thumb (also associated with diabetes, EtOH use)
- Asterixis (Liver flap)- Negative myoclonus can be caused by hepatic encephalopthy (hyperammonaemia) or ureaemia (renal failure), CO2 retention in T2RF
4
Q
Hands- Nails
A
- Koilonychia- spoon shaped nails, associated with IDA (malabsorption from chron’s disease)
- Leukonychia: Whitening of the nail bed, associated with hypoalbuminaemia (End-stage liver disease)
- Finger clubbing- associated with multiple systems for abdo it is IBD, Coeliac disease, liver cirrhosis, Lymphoma of GIT
5
Q
Arms
A
- Bruising- may suggest underlying clotting abnormalities 2’ liver cirrhosis
- Need track marks- IVDU are at higher risk of hepatitis
6
Q
Axillae
A
- Acanthosis Nigricans- darkening (hyperpigmentation) and thickening (hyperkeratosis) of the axillary skin can be benign but also associated with insulin resistance (T2DM) or GI malignancy
- Hair loss- IDA and malnutrition
7
Q
Eyes
A
- Conjunctival Pallor- suggestive of underlying anaemia
- Jaundice- associated with a build up of bilirubin in the blood/skin/mucus membranes- can be pre-hepatic, hepatocellular or choleostatic (obstruction of biliary tree)
- Corneal Arcus- white ring around iris associated with hypercholesterolaemia
- Xanthelasma- cholesterol deposits
- Kayser- Fleischer rings-Dark rings that encircle the iris associated with Wilson’s disease a abdnormal copper processing in the liver
- Anterior uveitis may be associated with IBD
8
Q
Mouth
A
- Angular stomatitis- inflammatory condition affecting the corner of the mouth associated with IDA, B12, Folate deficiency (malabsorption/malignancy GI)
- NB angular stomatitis is also associated with mechanical factors, infective and dermatological factors
- Glossitis- smooth erythemtous enlargement of the tongue associated with B12, Fe, Folate deficiency (e.g. malabsorption due to IBD)
- Oral candidias- a fungal infection commonly associated with immuno suppression,
- Aphthous ulceration- round or oval ulcers occuring on the mucous membrane inside the mourth, typically benign or trauam but can be Fe, B12, folate deficeny or Chron’s disesae
- Hyperpigmented macules- Peutz-Jeghers syndrome (Autosomal dominant) development of polyps in the GIT
9
Q
Neck
A
- Verchow’s node can be one of the first clinical signs of metastatic intrabdominal malignancy
- The left supracclavicular node receive lymphatic drainage from the abdominal cavity
10
Q
Chest
A
- Spider Naevi- skin lesions resulting from increased oestrogen circulation, associated with liver cirrhosis
- Gynaecomastia- enlargement of the male breast tissue as a result of increased circulating oestrogen. (can be caused by spironolactone + aripiprazole)
11
Q
Abdo inspection
A
- Scars- previous surgery
- Distension- can be caused by Fat, Fluid, Flatus, Faeces or Fulminant masses
- Caput medusae- Engorged umbilical veins associated with portal hypertension
- Striae (stretch marks)- ascities, malignancy, cushings syndrome, obesity, pregnancy
- Hernia
- Cullens- bruising of umbilicus (haemorrhagic pancreatitis)
- Grey-Turners- Bruising around the flanks (Haemorrhagic pancreatitis
12
Q
Light palpation
A
- Tenderness
- Rebound tenderness- compress slowly and rapidly release resulting in severe pain. associated with peritonitis (e.g. appendicitis)
- Voluntary guarding- contraction of the abdominal muscles in response to pain
- Involuntary guarding- involuntary tension in the abdominal muscles that occurs on palpation associated with peritonitis (appendicitis + diverticulitis)
- Rovsing’s sign- palpation of left illiac fossa causes pain to be experienced in the right iliac fossa. The sign was historicaly said to be indicative of appendicitis
- Masses- if large or superficial masses
13
Q
Deep palpation of the abdomen
A
- Deep palpation to identify deeper masses
- Location- which region
- Size and shape
- Consistency- smooth, soft, hard, irregular
- Mobility: assess if the mass appears to be attached to underlying structures
- Pulsatility- note is pulsatile (vascular aetiology) e.g. AAA
14
Q
Causes of hepatomegaly
A
- Hepatitis (infective or non-infective)
- Hepatocellular carcinoma + Mets
- Wilson’s disease
- Haemochromatosis
- Leukaemia
- Myeloma
- Glandular fever
- Primary Biliary Cirrhosis
- Tricuspid regurgitation
- Haemolytic anaemia
15
Q
Murphy’s sign + palpation of the gallbladder
A
- Murphy’s sign- position fingers at the right costal margin in the mid-clavicular line at the liver edge
- Ask the patient to take a deep breath.
- If the patient stops mid-breath, this suggests the presenance of cholecystitis
- Feel for masses
- Tenderness suggests cholecystitis
- Distended painless gallbladder suggests underlying pancreatic Ca (+/- jaundice)
