Abdominal Exam

Question 1

Clubbing

Answer 1

Cirrhosis
IBD
Coeliac’s

Question 2

Leukonychia

Answer 2

Hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption/malnutrition)

Question 3

Koilonychia

Answer 3

IDA

Question 4

Palmar erythema

Answer 4

Hyperdynamic circulation due not increased oestrogen in chronic or severe acute liver disease
Also- pregnancy, thyrotoxicosis, RA, drug-induced

Question 5

Dupuytren’s contracture

Answer 5

Familial

Cirrhosis (particularly alcoholic)

Question 6

Flapping tremor (asterixis)

Answer 6

Ask patient to hold out their hands in front of them extended at the wrist for 30s
Hepatic encephalopathy (grade >or-2)

Question 7

Pulse

Answer 7

e.g. increased in hypovolaemia (GI bleeding/shock) or anaemia

Question 8

Jaundice of skin

Answer 8

Liver disease

Cholestasis

Question 9

Slate-gray appearance

Answer 9

Haemochromatosis

Question 10

Hyperpigmentation

Answer 10

Addison’s disease

Question 11

Mucosal pallor of conjunctiva

Answer 11

Anaemia

Question 12

Jaundice of sclera

Answer 12

Liver disease

Cholestasis

Question 13

Red sclera

Answer 13

Anterior Uveitis (IBD)

Question 14

Corneal arcus

Answer 14

Hypercholesterolaemia in cholestasis (significant only if <50)

Question 15

Kayser-Fleisher rings

Answer 15

Wilson’s disease

Question 16

Xanthelasma

Answer 16

Hypercholesterolaemia in cholestasis

Question 17

Angular stomatitis

Answer 17

Severe anaemia (iron/ B12)

Question 18

Ulcer’s

Answer 18

Crohn’s disease

Question 19

Breath- fetor hepaticus

Answer 19

Sweet feculent smelling breath

Late sign in liver failure and hepatic encephalopathy

Question 20

Breath- ketosis

Answer 20

Sickly sweet ‘pear drop’ smelling breath

Question 21

Breath- uraemia

Answer 21

Fishy smelling breath

Question 22

Breath- bowel obstruction

Answer 22

Feculent smelling breath

Question 23

Glossitis

Answer 23

Vitamin B12/folate deficiencies

Question 24

Macroglossia

Answer 24

Amyloidosis
Acromegaly
Hypothyroidism
Down syndrome
Malignancy

Question 25

Oral candidiasis

Answer 25

Immunosuppression | Poor oral hygiene

Question 26

Virchow’s node

Answer 26

Troisier’s sign for intra-abdominal malignancy

Question 27

Spider naevi

Answer 27

Found in distribution of SVC (face, neck, arms, upper trunk) >5 is pathological If pressed will refill from the centre Due to increased oestrogen in chronic or severe acute liver disease

Question 28

Gynaecomastia

Answer 28

Due to increased oestrogen in liver disease

Question 29

Distension- 5 Fs

Answer 29

``` Fluid Fat Flatus Foetus Faeces ```

Question 30

Caput medusae

Answer 30

Portal hypertension

Question 31

Peristaltic waves

Answer 31

Normal (thin, fit, young individuals) or bowel obstruction

Question 32

Striae

Answer 32

Teenagers Obesity Pregnancy Ascites

Question 33

Stomas

Answer 33

Typically colostomies in LIF and ileostomies and urostomies in RIF

Question 34

Skin discolouration in pancreatitis

Answer 34

Cullen’s sign- umbilicus and surrounding skin | Gray-Turner’s sign- flanks

Question 35

Hernias

Answer 35

Observe cough impulse

Question 36

Roving’s sign

Answer 36

Pain in RIF>LIF when palpating LIF

Question 37

Appendicitis

Answer 37

Local peritonitis in RIF | Positive Rovsing’s sign

Question 38

Murphy’s sign

Answer 38

Local peritonitis in RUQ

Question 39

Acute cholecystotitis

Answer 39

positive murphy’s sign

Question 40

If degree of extension below costal margin in liver palpation is more than 2cm, there is

Answer 40

Hepatomegaly

Question 41

Smooth liver edge

Answer 41

Hepatomegaly

Question 42

Irregular liver edge

Answer 42

HCC

Question 43

Tenderness when palpating gallbladder

Answer 43

Hepatitis | Cholecystitis

Question 44

Liver pulsatility

Answer 44

Tricuspid regurgitation

Question 45

Tender RUQ

Answer 45

Murphy’s sign- acute cholecystitis

Question 46

Palpable gallbladder but not tender/no pain but jaundice present

Answer 46

Courvoisier’s law- likely pancreatic cancer or cholangiocarcinoma, rather than related to gallstones

Question 47

Bilaterally enlarged kidneys

Answer 47

Polycystic kidneys | Amyloidosis

Question 48

Unilaterally enlarged kidney

Answer 48

Renal tumour

Question 49

Tinkling bowel sound

Answer 49

Bowel obstruction

Question 50

Absent bowel sound for at least 3 minutes

Answer 50

Paralytic ileus | Peritonitis

Question 51

Pedal oedema

Answer 51

Hypoalbuminaemia

Question 52

Further tests

Answer 52

Offer to check Hernial orifices (e.g. signs of bowel obstruction) Examine external genitalia (referred pain from e.g. testicular torsion) Perform a DRE (e.g. suspicion of GI bleeding)