Abdo Exam Flashcards
(33 cards)
Facial stigmata of liver disease
- parotid enlargment
- frontal balding
- temporal muscle wasting
- fetor hepaticus
- conjunctival icterus
- jaundice
Stigmata of liver disease - Hands
- Tere’s nails (whitening at base of nailbeds)
- Leukonychia (white discolouration of nailbeds from albumin deficiency)
- Palmar erythema
- Thenar and hypothenar atrophy
- Asterixis
- Dupuytren’s contracture
Stigmata of liver disease - Abdo
- spider angiomas
- capus medusae
- gynecomastia
- hypogonadism
- ascites
Cullen’s sign
Bruising around the umbilicus
Grey-Turner Sign
Flank bruising
Tests for ascites
- Fluid wave (pt hand on middle, tap sides)
- Shifting dullness (percuss laterally til dullness, then turn, tympanic if fluid shift)
Castell’s Sign
Spleen
- percuss last ICS at anterior axillary line
- positive if dull on inspiration
Traube’s Space
Spleen: percuss 6th ICS anterior axillary line, follow costal margin inferiorly
McBurney’s Point
Appendicitis - 1/3rd of the way from the ASIS to the umbilicus on right side
Rovsing’s Sign
Appendicitis - palpate LLQ, assess for pain in RLQ
Psoas’ sign
Right knee 90 degrees
Press against thigh with resistance from patient
Obturator sign
Right knee and hip at 90 degrees
rotate ankle laterally
Murphy’s Sign
Cholecystitis - palpate right costal margin at MCL, pt inspires.
Don’t forget to palpate…
Liver: start low on right side
Spleen: start at RLQ, move to LUQ
Visceral pain
- gnawing, cramping, aching
- poorly localized, generally midline
- associated with N/V
- from acute stretch and ischemia of visceral organs
Parietal pain
- constant aching or intermittent sharp
- more localized over affected structure
- from inflammation
Radiation site of cholecystitis pain
Right shoulder (irritation of diaphragm and phrenic nerve)
Other questions for abdo pain:
Onset - sudden or long-term?
Position - worse when supine? (GERD)
Charcot’s Triad
Acute ascending cholangitis (bile duct infection)
- Fever
- RUQ pain
- Jaundice
Reynold’s Pentad
Acute suppurative cholangitis - obstructive infection of bile duct:
- Fever
- Jaundice
- RUQ pain
- Altered mental status
- Hypotension
Altered BMs
- Food sensitivity?
- Last BM?
- Passing gas? (partial vs complete bowel obstruction)
- Bristol chart (1 - 2 = constipation; 5-7 = diarrhea)
- Colour (melena, hematochezia, hemorrhoids/BRBPR)
Questions to ask with jaundice
- Clay/pale stools
- Dark urine
If suspecting GI blood volume loss, you should assess..
Orthostatic BP! Supine --> standing x 1 min 30-20-10 - HR up 30 bpm - SBP down 20 mmHg - DBP down 10 mmHg
To ask about if considering stigmata of liver disease…
Pruritis
