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Abdominal examination Flashcards

1
Q

Steps in abdo exam in general

A
  1. Face - ?Moon face/ Cooley’s / Cafe au lait/ pallor/ ? Jaundice/ KF rings/ Cataract
  2. Comment on growth status
  3. Hand - Liver palm, clubbing, rickets change (wrist swelling)
  4. Ankle - oedema
5. Thorough abdominal examination:
• Inspection
• Palpation
• Percussion
• Auscultation
• PR and Genitalia
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2
Q

Causes of abdominal distension

A
  1. Gaseous distension - malabsorption
  2. Organomegaly - Liver, spleen, kidneys, bladder
  3. Ascites
  4. Tumour - Wilm’s; Neuroblastoma
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3
Q

Ascitic fluid

A

Exudate: > 40g /L protein
Transudate:

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4
Q

Causes of ascites

A
  1. Local disease
    • Peritoitis
    • Malignancy
2. Others
• Decrease osmotic pressure
• Nephrotic Syndrome
• Protein losing enteropathy
• Chronic liver disease
• Increase hydrostatic pressure
• Portal hypertension
  1. Bile
  2. Chylous
  3. Uropathic
  4. Blood
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5
Q

Steps in examination

A
  1. General:
    • Growth - Height, ?Obese, wasting in malnutrition
    • Face - moon face in Cushing syndrome (Steroid)
    • Pallor, Jaundice and oedema
2. Abdomen: 
• Distention - everted umbilicus
• Evidence of portal hypertension
• Inguinal hernia
• Demonstrate shifting dullness
  1. Chest: Pleural Effusion
  2. CVS: Constrictive Pericarditis or congestive heart failures
  3. BP measurement
  4. Urinanlysis
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6
Q

Causes of gaseous distension

A
  1. Aerophagia
  2. GE
  3. GI Obstruction- acute or chronic eg. Hirschsprung’s disease
  4. Malabsorption - esp coeliac disease
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7
Q

Steps in examination

A
  1. Signs of malnutrition- wasting, loss of subcutaneous fat at buttock, face
  2. Abdomen - masses, bowel sounds, hernial sites, tympanic abdomen on percussion, perineal rash - due to acidic stool
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8
Q

Causes of splenomegaly

A

• MODERATE Size

  1. Portal hypertension
  2. Blood diseases - Spherocytosis
  3. Infection - Viral, Subacute bacterial endocarditis, Toxoplasmosis, Malaria, Typhoid
  4. Juvenile RA
  5. Malignancy

• MASSIVE Size

  1. Chronic myeloid leukaemia
  2. Myelofibrosis
  3. Malaria
  4. Gaucher disease
  5. Thal Major
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9
Q

Hepatomegaly

A

Size in newborn - 3 cm below Rt costal margin
1 year old - 2cm below Rt costal margin
5 year old - 1 cm below

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10
Q

Causes of Hepatomegaly

A

• New born:

  1. Neonatal hepatitis
  2. Biliary Atresia
  3. Congestive HF
  4. Infection
  5. Haematological disease eg. Haemolytic disease of the newborn (HDN), Haemoglobinopathy, chronic haemolysis

• Age 1 to 3 (Toddler)

  1. Congestive HF
  2. Infection
  3. Haematological disease eg. Haemolytic disease of the newborn (HDN), Haemoglobinopathy, chronic haemolysis
  4. Metabolic disease (Galactosaemia, Storage disease, Reye’s syndrome, Wilson’s disease, Alpha 1 antitrypsin deficiency)
5. Tumour
A. MALIGNANT
• Primary - Hepatoblastoma
• Secondary - Lymphoma, Leukaemia
B. BENIGN
• Heamangioma, Cyst / Abcess

• Older children:

  1. Infection
  2. Haematological disease eg. Haemolytic disease of the newborn (HDN), Haemoglobinopathy (Thal), chronic haemolysis
  3. Metabolic disease (Galactosaemia, Storage disease, Reye’s syndrome, Wilson’s disease, Alpha 1 antitrypsin deficiency)
4. Tumour
A. MALIGNANT
• Primary - Hepatoblastoma
• Secondary - Lymphoma, Leukaemia
B. BENIGN
• Heamangioma, Cyst / Abcess
  1. Chronic Inflammatory disease - Still’s, Crohn’s, UC
  2. Polycystic liver
  3. Congenital fibrosis
  4. Amyloidosis
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11
Q

Steps in examination in Hepatomegaly

A
  1. General: growth, ?wasting
  2. Assess mentality
  3. Face: Pallor, Jaundice, increase pigmentation, Cooley’s face, dysmorphic face
  4. Eye - Cataract, KF rings, Puffy eyelid
  5. Hand: Clubbing, Liver palm
  6. Limbs: Oedema; Bleeding tendency - Bruise and petechiae
  7. Abdomen
    • Sign of portal hypertension
    • Organomegaly
    • Isolated liver enlargement (Galactosaemia, Glycogen Storage disease, Alpha 1 anti-trypsin deficency
  8. CVS for evidence of HF
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12
Q

Causes of Hepatosplenomegaly

A
  1. Infection- Typhoid, TB, Infectious Mononucleosis, CMV, Malaria
  2. Extramedullary erythropoiesis - Thal, Haemoglobinopathy
  3. Malignancy - Neuroblastoma and Hiistiocytosis
  4. Portal Hypertension
  5. Storage disease - Gaucher’s disease
  6. Polycystic liver disease

NB. Look for pallor, LNs and signs of liver disease

If Hepatosplenomegaly + LNs, consider:

  1. CLL
  2. Lymphoma
  3. IM
  4. Infective Hepatitis
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13
Q

Causes of Portal Hypertension

A
  1. Prehepatic
    • Portal vein thrombosis
    • Sepsis, Polycythaemia, Catheterization
    • Portal Lymphadenopathy
2. Hepatic
•  Cirrhosis
•  Veno- occlusive diseases
•  Infiltrative disease, eg Malignancy
•  Schistosomiasis
•  Congenital fibrosis (AR)
  1. Posthepatic
    • Budd Chiari Syndrome
    • Congestive HF
    • Constrictive pericarditis
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14
Q

Causes of kidney enlargement

A 
1. Unilateral 
• Renal cyst
• Hydronephrosis
• Pyelonephritis
• Tumor - Wilms tumor; Neuroblastoma
2. Bilateral 
• Cystic kidney
• Polycystic kidney disease
• Megacystis megaureter syndrome
• Lowe's syndrome
• TS
• Hydronephrosis due to bilateral reflux, neurogenic bladder, posterior urethral valve
• Bilateral Wilm's tumor
• Renal vein thrombosis (in neonate)
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15
Q

Steps in physical examination in kidney enlargement

A
  1. Note pallor, uraemic look or polycythaemia, short statue, wasting, oedema, bone deformity and ricketic change, Aniridia
  2. Abdo exam - test the anal reflex if bladder is palpable
  3. Examination of spine and LL neurologically if indicated
  4. Measure BP and look at fundi for uraemic change and ask for urine analysis
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16
Q

Causes of palpable bladder

A
  1. Normal in child who is ready to void
2. Obstruction of bladder neck:
• Posterior urethral valve
• Stone
• Urethral stricture
• Rhabdomyosarcoma
  1. Neurogenic bladder
    In girls - ddx including hydrocolpos or haematocolpos
17
Q

Steps in examination in the case of palpable bladder

A
  1. Note the short statue, uraemic look, hydrocephalus
  2. Abdo exam- esp look for enlarged kidneys; Anal tone and reflex
  3. Spine examination for scar/ Mass/ hairy patch
  4. LL neurological exam
18
Q

Umbilical Hernia

A
  1. Cretinism
  2. Beckwith Wiederman syn
  3. MPS
  4. Downs syn
  5. African children / Preterm baby
  6. Increase intra- abdominal pressure
19
Q

Causes of Left lower quadrant mass

A
  1. Faecal masses
  2. UC - abcess
  3. Psoas Abscess
  4. Ectopic kidney/ transplant kidney
20
Q

Causes of Right lower quadrant mass

A
  1. Appendix abcess
  2. Crohn’s disease or ulcerative colitis
  3. TB with psoas abscess
  4. Ectopic kidney
  5. Meconium ileus equivalent

Paeds (53 decks)

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