Abdo Flashcards
What is the appropriate position for an abdo examination?
pt lies supine (flat)
What are you looking for when conducting general inspection? (Abdo)
Patient:
- stable
- pain/discomfort
- jaundice
- pallor
- muscle wasting/cachexia
- distension
- scars
Around bed:
- vomit bowels etc
MUST ASK PT ABOUT TATTOOS OR BRUISES
What are you looking for when conducting an examination on the hands (Abdo)?
Inspection:
excoriation, petechiae, haemodialysis fistulae & see image
Palpation
- radial pulse
- BP
How long must liver flap be assessed for?
30sec
What are you looking for when conducting anb abdo examination on the face?
Inspects Eyes
- Conjunctival pallor, Scleral icterus
Inspects Mouth
- Pigmentation, Telangiectasia, Hydration, Dentition, Apthous ulcers, Angular stomatitis, Atrophic glossitis, candidiasis
What must be done when conducting an abdo exam on the neck & back?
PATIENT MUST SIT FORWARDS
Neck
Inspection:
- JVP
- aconthosis nigricans
Palpation
- Left supraclavicular lymph node (Virchow’s Node) for Troisier’s sign (full neck lymph node examination)
Back
Inspection:
- spider naevi (>5 significant), skin lesions (immunosuppression)
What must be done on inspection of the abdomen?
PATIENT CAN SIT BACK
Chest
1)General Inspection:
- spider naevi (>5 significant)
- gynaecomastia
- loss of hair (all due to ↑oestrogen levels in liver disease/pregnancy)
- Scars
- distension
- caput medusa
- pulsations
- Cullen’s & Grey-Turner’s sign
- striae
- stomas/nephrostomies
2) Ask pt to cough –> look for incisional hernias
What must be done if spider naevi are seen on the abdomen?
Must press down on them –> blanches –> reddens again on release
What is
a) grey-turner’s sign?
b) cullen’s sign?
What could abdominal distension be due to?
Fluid, Flatus, Fat, Foetus, Faeces
What must be done after inspection of the abdomen?
1. Palpation
FIRST ASK ABOUT PAIN!
a) superficial
- watch pt’s face
look for:
- tenderness
- guarding
- rebound tenderness
b) deep
look for:
- masses
- deep tenderness
- Rovsing’s sign (appendicitis)
- Murphy’s sign (cholecystitis)
c) respiratory palp.
Liver: RIF –> right costal margin
(hepatomegaly = metastasis/HCC, cirrhosis, hepatitis, RVF, leukaemia/ lymphoma)
Spleen: RIF –> left costal margin
(splenomegaly = lymphoma/ leukaemia, myelofibrosis, malaria, portal hypertension, haemolysis)
d) kidney palpation
- hand in on expiration, ballot on inspiration
e) AAA palpation
- (pulsatile mass can be normal, expansile mass is AAA)
2. Percussion
a) liver
b) spleen
c) flanks - horizontally
3. Auscultation
a) at ileocaecal valve in RLQ until heard, up to 1min (tinkling = obstruction; absent = paralytic ileus/peritonitis)
b) 1cm superior & lateral to umbilicus bilaterally - for Aortic/renal bruits
1) on percussion of the flanks what sound must be heard (abdo)?
2) If this sound is not heard, what must be done?
1) resonant
2) if a dull percussion note is heard in flanks
a) demonstrate shifting dullness (patient roll to side and percuss all way across again)
b) ± fluid thrill (patients hand hard on abdomen mid-line and tap one side and feel other) (ascites)
What must be done before concluding the examination (abdo)?
check for ankle oedema
What further investigations can be done to complete the examination? (abdo)
- Check hernial orifices
- examine external genitalia
- DRE
- urine dipstick
