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CFB > WCS07 Examination Of The Abdomen > Flashcards

WCS07 Examination Of The Abdomen Flashcards

1
Q

General examination

A
  1. Signs of relevance
    - LN
    - pallor
  2. Stigmata of liver disease
    - Jaundice (uncommon)
    - Spider angioma
    - Telangiectasia
    - **Palmar erythema
    - **    Finger clubbing
    - **Dupuytren’s contracture
    - **    Leukonychia
    - ***Flapping tremor
    - Fetor hepaticus
    - Gynaecomastia
    - Ankle pigmentation +/- Leg ulcers
    - Fluid retention
    - Easy bruising, Purpura (bleeding under SC tissue, do not disappear after pressing)
    - Hepatic encephalopathy
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2
Q

Spider angioma

A
  • dilated ***central arteriole spreading outwards
  • face, oral, nasal mucous membrane
  • ***SVC drainage area
  • rarely below nipple
    —> Normal (<3 on face)
    —> Cirrhosis
    —> Hepatitis
    —> RA
    —> Pregnancy
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3
Q

Telangiectasia

A
  • dilated ***capillary
  • paper money skin
  • same significance as spider angioma
    —> Scleroderma
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4
Q

Palmar erythema

A
  1. Chronic liver disorder
  2. RA
  3. Pregnancy
  4. Thyrotoxicosis
  5. Chronic febrile illness
  6. Chronic leukaemia
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5
Q

Finger clubbing

A
  • Deposition of SC tissue under nail
  • press on junction between nail and nail bed

4 stages
- Grade 1: floating sensation / fluctuation / softening of nail bed
- Grade 2: loss of angle between proximal nail fold (nailbed) and nail plate (nail) ∵ ↑ SC tissue
- Grade 3: increased longitudinal curvature of nail
- Grade 4: drumstick appear of fingertips
—> Cyanotic congenital heart disease
—> Infective endocarditis
—> Lung cancer
—> Chronic suppurative lung conditions (e.g. bronchiectasis, empyema) (X TB)
(—> ILD (self notes))
—> Liver conditions (Cirrhosis, Liver abscess)
—> GI (Crohn’s, UC)

記: 2 cardiac causes, 2 respi causes, 2 GI causes

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6
Q

Dupuytren’s contracture

A
  • contracted palmar aponeurosis
  • affect 4th + 5th tendon first
    —> Normal
    —> Cirrhosis (esp. ***Alcohol-related)
    —> DM
    —> Systemic fibrosclerosing syndromes
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7
Q

Leukonychia

A
  • different from cyanosis (can still see crescent)
  • cannot see crescent
  • ***Hypoalbuminaemia
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8
Q

Flapping tremor

A
  • severe hepatocellular decompensation
  • ***Hepatic encephalopathy
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9
Q

Fetor hepaticus

A

Probably intestinal origin
—> severe hepatocellular decompensation
—> extensive collateral circulation —> portal-systemic shunt to lungs

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10
Q

Gynaecomastia

A
  • Alcoholic cirrhosis
  • Puberty
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11
Q

Ankle pigmentation +/- Leg ulcers

A

Associated with hypersplenism
—> regress after splenectomy

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12
Q

Hepatic encephalopathy

A

Confused, slurred speech
—> Drowsy, inappropriate behaviour
—> Stuporous, obeying simple commands
—> Coma
—> Deep coma, no spontaneous movement

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13
Q

Obstructive Jaundice

A
  1. Greenish jaundice
  2. Xanthelesma (Cholesterol crystal)
  3. Xanthoma (Cholesterol crystal) —> extensor surfaces, knee
  4. Scratch marks (deposition of bile salt —> pruritis)
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14
Q

Inspection

A

End of bed

  1. Shape
    - Normal / Scaphoid / Distended (屎肥仔汽水)
  2. Symmetry
  3. Mass / Swelling
  4. Dilated veins
    - IVC obstruction
    - Portal hypertension (i.e. Caput medusae) (由肚臍散出去)
    —> observe direction of flow below umbilicus
  5. Scars
  6. Striae
    - acute abdominal distension with SC bleeding e.g. Ascites, Pregnancy
    - white vs purple (Cushing’s syndrome)
  7. Pigmentation
    - pregnancy
    - Addison’s disease
  8. Movement
    - Thoraco-abdominal respiration
    - Epigastric pulsation e.g. thin patients, transmitted pulsation
    - Visible peristalsis in intestinal obstruction
  9. Umbilicus
    - normal, depressed in fat abdomen
    - bulging / everted with increased ***intraabdominal pressure e.g. Ascites (horizontal slit vs pregnancy: vertical slit)
  10. Visible peristalsis
    - Intestinal obstruction
  11. Visible pulsation
    - aneurysm
  12. Hernia
    - Incisional (diastasis recti)
    - Groin (cough impulse: cough / lift head up / standing)
  13. Ecchymosis / Bruising
    - Cullen’s sign —> Umbilical
    - Grey-Turner’s sign —> Flank
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15
Q

Palpation

A

Sit down
Ask for pain

  1. 9 areas
    - feel for tenderness
    - feel for mass
    - ***Peritoneal signs
    —> Tenderness
    —> Guarding (involuntary contraction against pressure)
    —> Rigidity (generalised contraction)
    —> Rebound tenderness
    —> Absent bowel sound (ileus due to diffuse peritonitis)
  2. Liver
  3. Spleen
  4. Kidneys
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16
Q

Liver

A
  1. Palpation
    - hand avoid rectus muscle
    - hand parallel to liver lower border
    - extend hand to cover left lobe (normally cannot feel due to rectus muscle)
    - deep breath
    - normal liver maybe palpable on inspiration or it can be pushed down by thoracic abnormalities e.g. emphysema
  2. Percussion
    - finger parallel to liver dullness
    - resonant to dull
    - move perpendicularly
    - percuss above costal margin
    - epigastrium for ***left lobe
    - upper border: from above downwards
  3. Liver span
    - measure at Mid Clavicular Line
    - upper border: 5th ICS
    - lower border: Costal margin, Mid Clavicular Line
    - span: 10cm
  4. Edge
    - sharp / rounded
  5. Surface
    - smooth / nodular (small nodules usually cannot feel, only large nodule: HCC)
    - **Smooth: Fatty liver, alcoholic cirrhosis, primary biliary cholangitis
    - **    Nodular: Polycystic kidney and liver disease
    - ***Large nodules: HCC
  6. Consistency
    - soft / firm / hard
    - ***Hard: Cancer
  7. Tenderness
  8. Bruit
    - vascular tumour (e.g. HCC) —> heard all over
    - alcoholic hepatitis —> heard all over
    - compression of aorta —> turn patient to right side and bruit less prominent
17
Q

Spleen

A
  1. Palpation
    - deep breath
    - fingers parallel to Gardner’s line (umbilicus to left anterior axillary fold)
  2. Hooking
    - right lateral position
    - renal angle (lateral border of erector spinae + lowermost rib)
  3. Percussion
    - finger perpendicular to Gardner’s line
    - percuss above costal margin
    - spleen is dull (∵ anterior structure)
  4. Dipping (for Ascites)
    - dip hand to push down spleen and then allow it to float upwards again
    - dip on lateral side also
18
Q

Kidney

A
  1. Palpation
    - Renal angle
    - deep breath
    - feel something —> bimanual palpation
    - right kidney lower than left
  2. Percussion
    - partially resonant (∵ overlaid by small intestines + colon)
19
Q

Distinguish between enlarged spleen vs left kidney

A

1.
Spleen: Anterior
Kidney: Retroperitoneal (∴ bimanually palpable)

2.
Spleen: No subcostal gap
Kidney: Subcostal gap present

3.
Spleen: Dull
Kidney: Always partially resonant (∵ overlaid by intestine)

4.
Spleen (>10cm): Notches along medial border
Kidney: No notches

5.
Both move up and down with respiration

20
Q

Other mass

A
  1. Site
  2. Size
  3. Shape
  4. Localisation
    - abdominal wall: lift head to make mass more prominent
    - intraperitoneal vs retroperitoneal: less prominent, turn patient to right side, intraperitoneal organ drops and easier to feel
  5. Movement (with respiration / by itself)
  6. Tenderness
  7. Consistency
  8. Pulsation
21
Q

Ascites

A
  1. From resonant to dull
  2. Fingers: **parallel but **move perpendicularly to line of dullness
  3. Right lateral position —> new line of dullness —> shifting dullness (previously dull area now resonant)
    - not sensitive, require >=1L of fluid
  4. Fluid thrill
    - flick on one side and feel for transmitted thrill on other side
    - much less sensitive
22
Q

Auscultation

A
  1. Bowel sounds
    - Hyperactive:
    —> After meal
    —> ***Intestinal obstruction
  • Hypoactive:
    —> **Peritonitis
    —> after surgical operation —> **    Adynamic ileus
  1. Liver bruit
  2. Splenic rub
  3. Renal bruit (Renal artery stenosis):
    - midway between xiphisternum and umbilicus
    - lateral to rectus muscle
  4. Succussion splash of stomach
    - pyloric stenosis

CFB (43 decks)

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