Physical Signs

Question 1

What is jaundice?

Answer 1

Yellowish skin discolouration due to excess bilirubin in the blood (bilirubin >35umol/L)
Demonstrable clinically when bilirubin >40 with scleral jaundice or buccal jaundice

Question 2

What is cachexia?

Answer 2

Cachaexia demonstrable by muscle and fat loss
- Wasting of temporalis muscle
- Reduced triceps skin-fold thickness

Question 3

Where can you demonstrate anaemia?
Why is anaemia an important sign in chronic liver disease?

Answer 3

Anaemia is demonstrable by:
- Conjunctival pallor
- Skin crease pallor
- Nail pallor
- Mucosal membrane pallor

Causes of anaemia in chronic liver disease is severe:
- Portal hypertension variceal bleeding
- Alcoholism causing bone marrow suppression
- Poor nutrition

Question 4

What are the gastrointestinal causes of clubbing?

Answer 4

1. Chronic liver disease
2. Inflammatory bowel disease
3. Coeliac disease
4. GI lymphoma
5. Tropical sprue
6. Whipple’s disease

Question 5

What is leuconychia?
What are the causes of leuconychia?

Answer 5

Whiteness of nails either partial or complete, in spots or streaks

Causes of leuconychia
1. Hypoalbuminaemia
2. Heart failure
3. Renal disease
4. Hodgkin’s lymphoma
5. Diabetes mellitus
6. Fingernail trauma

Question 6

How is sex hormone altered in chronic liver disease or pregnancy?
What are the consequent physical signs of such alterations?

Answer 6

Increase in oestradiol to free testosterone ratio

Presents with:
- Spider naevi: central arteriole supplying surrounding vessels, blanchable
- Palmar erythema
- Gynaecomastia
- Loss of body hair

Question 7

What are the causes of a right upper quadrant mass?

Answer 7

Liver
Right kidney
Gallbladder
Colon

Question 8

What are the causes of a left upper quadrant mass?

Answer 8

Spleen
Left kidney
Pancreas
Colon

Question 9

What are the causes of a right lower quadrant mass?

Answer 9

Colon
Small intestine
Appendix
Pelvic mass

Question 10

What are the causes of a left lower quadrant mass?

Answer 10

Sigmoid colon

Pelvic mass

Question 11

What are the causes of gynaecomastia?

Answer 11

Puberty and senility
Genetic: Kleinfelter’s
GI: Cirrhosis
Drugs: Spironolactone, Digoxin
Endocrine: Thyroid disease, Addison
Testicular tumour

Question 12

Approach to Abdominal Scars

Answer 12

Question 13

Inspection of Abdomen Station

Answer 13

Question 14

Presentation in Short Case

Answer 14