What should you look for in general inspection?
State - stable, pain/discomfort
Skin - jaundice, bronze pigmentation (haemochromatosis), pallor
Size - cachexia, gynaecomastia
Surroundings - vomit bowls etc.
What should you look for in the nails?
- Clubbing
- Leukonychia
- Koilonychia
What are some GI causes of clubbing?
- Liver cirrhosis
- IBD
- Coeliac
What causes leukonychia?
Hypoalbuminaemia (liver cirrhosis)
What kind of tremor might be seen in patients with GI pathology?
Flapping tremor - hepatic encephalopathy
What should you look for on the palms?
- Palmar erythema
- Dupuytren’s contracture
- Fingertip capillary glucose monitoring marks
What causes palmar erythema?
- Liver disease, pregnancy (inc. circulating oestrogen)
- Thryotoxicosis
- Polycythaemia
What should you look for in the arms, neck and axillae?
- Bruising
- Excoriations (scratch marks)
- Spider naevi
- Acanthosis nigricans
- Lymphadenopathy
What are spider naevi associated with?
> 2-3 associated with liver cirrhosis
What should you look for in the eyes?
- Sclera (jaundice)
- Conjunctival pallor
- Periorbital xanthelasma
- Kayser-Fleischer rings (Wilson’s disease)
What should you look for in the mouth?
- Glossitis
- Macroglossia
- Apthous ulcers
- Gum hypertrophy
- Breath odor
What should you look for on the abdomen?
- Distension (fluid, flatus, fat, foetus, faeces)
- Incusional hernias
- Scars
- Striae
- Spider naevi
- Movement with respiration
- Obvious pulsations
- Distended anastomoses
How do you examine for an abdominal aorta aneurysm?
- Align hands parallel to the aorta
- Start laterally and move medially
In what order do you do palpitations?
- Superficial
- Deep
- Liver
- Spleen
- Kidneys
Where do you auscultate for renal bruits?
Either side above the umbilicus
How do you improve palpation of the spleen?
Ask the patient to roll onto their right side with tucked legs
What are some causes of splenomegaly?
- Lymphoma
- Leukaemia
- Myelofibrosis
- Malaria
- Portal hypertension
- Haemolysis
What positioning do you want?
Exposed abdomen, lie flat
