Abdo Flashcards
Confusion (abdo)
end-stage liver disease (hepatic encephalopathy)
Causes of abdominal distension
ascities
bowel obstruction
organomegaly
Jaundice
a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels (e.g. acute hepatitis, liver cirrhosis, cholangitis, pancreatic cancer).
Hyperpigmentation
bronzing of skin
haemochromatosis
Oedema (abdo exam)
cirrhosis
Cachexia (abdo)
underlying malignancy: pancreatic/bowel/stomach
advanced liver failure
Hernias
may be visible from the end of the bed (e.g. umbilical/incisional hernia). Asking the patient to cough will usually cause hernias to become more pronounced
Medical paraphernalia of GI disease
Stoma bag(s): note the location of the stoma bag(s) as this can provide clues as to the type of stoma (e.g. colostomies are typically located in the left iliac fossa, whereas ileostomies are usually located in the right iliac fossa).
Surgical drains: note the location of the drain and the type/volume of the contents within the drain (e.g. blood, chyle, pus).
Feeding tubes: note the presence of feeding tubes (e.g. nasogastric/nasojejunal) and whether the patient is currently being fed.
Other medical equipment: ECG leads, medications, total parenteral nutrition, catheters (note volume/colour of urine) and intravenous access.
Mobility aids: items such as wheelchairs and walking aids give an indication of the patient’s current mobility status.
Vital signs: charts on which vital signs are recorded will give an indication of the patient’s current clinical status and how their physiological parameters have changed over time.
Fluid balance: fluid balance charts will give an indication of the patient’s current fluid status which may be relevant if a patient appears fluid overloaded or dehydrated.
Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications.
Gastro causes of anaemia
malignancy
GI bleed
malnutrition
Palmar erythema
a redness involving the heel of the palm that can be associated with chronic liver disease (it can also be a normal finding in pregnancy).
Dupuytren’s contracture
= thickening of palmar fascia
causes: genetics, excessive alcohol use, increasing age, male gender, diabetes
Koilonychia
spoon-shaped nails, associated with iron deficiency anaemia (e.g. malabsorption in Crohn’s disease).
Leukonychia
whitening of the nail bed, associated with hypoalbuminaemia (e.g. end-stage liver disease, protein-losing enteropathy).
Gastro causes of clubbing
IBD
Coeliac
Cirrhosis
Lymphoma
Asterixis
= flapping tremor
Causes: hepatic encephalopathy (hyperammonaemia), urea (renal failure), CO2 retention (T2RF)
Inspection of arms
Bruising: may suggest underlying clotting abnormalities secondary to liver disease (e.g. cirrhosis).
Excoriations: scratch marks that may be caused by the patient trying to relieve pruritis. In the context of an abdominal examination, this may suggest underlying cholestasis.
Needle track marks: important to note as intravenous drug use can be associated with an increased risk of viral hepatitis.
Axillae inspection
Acanthosis nigricans: darkening (hyperpigmentation) and thickening (hyperkeratosis) of the axillary skin which can be benign (most commonly in dark-skinned individuals) or associated with insulin resistance (e.g. type 2 diabetes mellitus) or gastrointestinal malignancy (most commonly stomach cancer).
Hair loss: loss of axillary hair associated with iron-deficiency anaemia and malnutrition.
Jaundice in eyes
most evident in the superior portion of the sclera (ask the patient to look downwards as you lift their upper eyelid).
Perilimbal injection
inflammation of the area of conjunctiva adjacent to the iris. Perilimbal injection is a sign of anterior uveitis, which can be associated with inflammatory bowel disease. Other clinical features of anterior uveitis include photophobia, ocular pain and reduced visual acuity.
Glossitis
smooth erythematous enlargement of the tongue associated with iron, B12 and folate deficiency (e.g. malabsorption secondary to inflammatory bowel disease).
Aphthous ulceration
round or oval ulcers occurring on the mucous membranes inside the mouth. Aphthous ulcers are typically benign (e.g. due to stress or mechanical trauma), however, they can be associated with iron, B12 and folate deficiency as well as Crohn’s disease.
Hyperpigmented macules in mouth
pathognomonic for Peutz-Jeghers syndrome, an autosomal dominant genetic disorder that results in the development of polyps in the gastrointestinal tract.
Virchow’s node
left supraclavicular lymphadenopathy
one of the first clinical signs of metastatic intrabdominal malignancy (gastric cancer) or metastatic oesophageal cancer (+ malignancy from thoracic viscera)
Spider naevi
skin lesions that have a central red papule with fine red lines extending radially caused by increased levels of circulating oestrogen. Spider naevi are commonly associated with liver cirrhosis, but can also be a normal finding in pregnancy or in women taking the combined oral contraceptive pill. If more than 5 are present it is more likely to be associated with pathology such as liver cirrhosis.
