Abdomen

Question 1

What marks on the skin do you look for on general inspection in an abdominal exam?

Answer 1

Scars: hx of surgery
Tattoos: increase risk of Hep C
Significant bruises: clotting disorder/ chronic liver disease

Question 2

What skin changes do you look for on general inspection in an abdominal exam?

Answer 2

Pallor: Anaemia: GI bleed/ malnutrition
Jaundice: Acute hepatitis, Liver cirrhosis, Cholangitis, Pancreatic Ca
Hyperpigmentation: Haemochromatosis

Question 3

What broad signs do you assess on general inspection in an abdominal exam?

Answer 3

Young = iBD
Old = Chronic liver disease/ malignancy
Confusion: end stage liver disease= hepatic encephalopathy
Abdominal distension: Ascites/ bowel obstruction/ organomegaly
Oedema: ascites/ pedal oedema- Liver cirrhosis
Cachexia: pancreatic/ bowel/ stomach ca
Hernias: umbilical/ incisional

Question 4

How does location of stoma bag indicate type?

Answer 4

RIF: Ileostomy
LIF: Colostomy

Question 5

What medical equipment should you look for on general inspection in an abdominal exam?

Answer 5

Surgical drains (location + contents)
Feeding tubes
Catheters
IV access

Question 6

What 3 signs should you look for on the palms in an abdominal exam?

Answer 6

Pallor: anaemia- GI bleeding, malnutrition
Palmar erythema:chronic liver disease, pregnancy
Dupuytren’s contracture: thickeningofpalmar fasci- alcohol related chronic liver disease. Risk: age, FHx, male, alcohol excess, diabetes

Question 7

What 2 signs should you look for on the nails in an abdominal exam?

Answer 7

Koilonychia:spoon-shaped nails: IDA (e.g. malabsorption in Crohn’s disease).
Leukonychia:whitening of nail bed: hypoalbuminaemia (e.g. end-stage liver disease, protein-losing enteropathy).

Question 8

List 4 GI related causes of clubbing

Answer 8

IBD
Coeliac
Liver cirrhosis
Lymphoma of Gi tract

Question 9

What is indicated by asterixis?

Answer 9

Liver failure

Question 10

What 6 signs should you look for on the arms in an abdominal exam?

Answer 10

Petechiae: clotting abnormalities
Haemodialysis fistula: chronic renal failure
Bruising: clotting abnormalities due to liver failure
Excoriations: Cholestasis
Needle track marks: Increased risk of viral Hepatitis
Hair loss in axilla: IDA, malnutrition

Question 11

What 6 signs should you look for in the eyes in an abdominal exam?

Answer 11

Conjunctival pallor:anaemia.
Jaundice: Scleral icterus
Corneal arcus:< 50 suggests hypercholesterolaemia.
Xanthelasma: hypercholesterolaemia.
Kayser-Fleischer rings:Wilson’s disease.
Perilimbal injection:Anterior uveitis, associated with IBD.

Question 12

What 6 signs should you look for in the mouth in an abdominal exam?

Answer 12

Angular stomatitis: IDA, IBD
Glossitis: Malabsorption secondary to IBD
Oral candidiasis: Immunosuppression
Aphtous ulcers: Trauma, Iron, B12, Folate deficiency, Crohns
Hyperpigmentation: Peutz Jeghers syndrome
Telangiectasia: Hereditary haemorrhagic telangiectasia

Question 13

Other than JVP, what do you look for in the neck in an abdo exam?

Answer 13

Troisier’s sign: metastatic intrabdominal malignancy
Palpable right supraclavicular lymph node: metastatic oesophageal cancer
Acanthosis nigricans: benign, insulin resistance, GI malignancy

Question 14

In which conditions may you see spider navaei?

Answer 14

Liver cirrhosis

Pregnancy

Question 15

Give 2 causes of gynaemcomastia

Answer 15

Liver cirrhosis causing increased levels of circulating oestrogen
Digoxin/ Spironolactone

Question 16

What causes chest hair loss in males?

Answer 16

Increased levels of circulating oestrogen in chronic liver disease + malnutrition

Question 17

List 8 features to look for on abdominal inspection

Answer 17

Pulsations (expansile AAA)
Stomas/ nephrostomies
Scar
Abdominal distension 
Caput medusae (portal HTN)
Striae
Hernias
Cullens + Grey Turners sign

Question 18

What are the 6 F’s of abdominal distension?

Answer 18

Fat
Flatus
Faeces
Fluid
Foetus
Fulminant mass

Question 19

What causes striae formation? List 4 examples

Answer 19

Tearing during rapid growth/ overstitching of skin
Ascites
Cushing's 
Obesity
Pregnancy

Question 20

What is indicated by Cullen’s and Grey-Turner’s sign? What is the main cause of this?

Answer 20

Retroperitoneal bleeding

Haemorrhagic pancreatitis

Question 21

How do colostomies differ from ileostomies?

Answer 21

I: RIF, liquid stool, spout
C: LIF, solid stool, flush to skin

Question 22

What are Lanz and Gridiron incisions used for? How do they differ?

Answer 22

Appendectomy
Lanz: Transverse
Gridiron: Oblique

Question 23

What incision may be used for cholecystectomy?

Answer 23

Kochers

Question 24

What may a midline incision be used for?

Answer 24

Laparotomy

Question 25

What may a paramedian incision be used to access?

Answer 25

``` Lateral viscera (kidneys, spleen, adrenals) Rare in UK ```

Question 26

What may a pfannenstiel incision be used for?

Answer 26

C section Cystectomy Prostatectomy

Question 27

What may a Rutherford-Morrison incision be used for?

Answer 27

Colonic resection

Question 28

What may a Chevron / rooftop incision be used for?

Answer 28

``` Oesophagectomy Gastrectomy Bilateral adrenalectomy Hepatic resections Liver transplantation ```

Question 29

What is a Mercedes Benz incision often used for?

Answer 29

Liver transplantation | + Chevron uses

Question 30

How do you elicit rebound tenderness? What does this indicate?

Answer 30

Compress abdo wall slowly, then rapidly release = sudden sharp pain Peritonitis

Question 31

What is guarding? In what condition is it seen?

Answer 31

Involuntary tension in abdo muscles | Peritonitis

Question 32

What is Rovsing's sign?

Answer 32

Palpation of the left iliac fossa causes pain in RIF | Appendicitis

Question 33

What may a cirrhotic liver feel like on palpation?

Answer 33

Nodular edge

Question 34

What would cause hepatic tenderness?

Answer 34

Hepatitis | Cholecystitis (may be palpating gallbladder)

Question 35

What is indicated by bilaterally enlarged ballotable kidneys?

Answer 35

Polycystic kidney disease | Amyloidosis

Question 36

What is indicated by unilaterally enlarged ballotable kidneys?

Answer 36

Renal tumour

Question 37

Give 2 signs indicating splenomegaly

Answer 37

Palpable spleen | Dull to percussion

Question 38

What do tinkling bowel sounds suggest?

Answer 38

Obstruction

Question 39

What does absence of bowel sounds suggest?

Answer 39

Ileus: disruption of normal propulsive ability of the intestine due to a malfunction of peristalsis. Causes: Electrolyte abnormalities + recent abdo surgery

Question 40

What do aortic or renal bruits suggest?

Answer 40

Aortic: AAA Renal: Renal artery stenosis

Question 41

What is the significance of pitting oedema in a GI examination?

Answer 41

Hypoalbunaemia: Liver cirrhosis Protein losing enteropathy