abdominal exam

Question 1

what should you note from the end of the bed?

Answer 1

• body habitus
• scars
• jaundice
• abdominal distention
• masses

Question 2

what to look for in hands?

Answer 2

• koilonychia- anaemia
• leukonichia- low albumin
• palmar erythema- liver disease
• deupetrons contracture- alcohol/ diabetes
• clubbing
• radial pulse
• check for liver flap - this is to look at if there is an increase in urea and the patient has hepatic encephlopathy

Question 3

why do you ask the patient to raise their arms?

Answer 3

to check for acanthosis nigracans

Question 4

what do you look for in the face and eyes?

Answer 4

• jaundice
• xanthalasma- hypercholesterolaemia
• kayser fleisher- copper deposition wilson disease

Question 5

what should you look for in the mouth?

Answer 5

glositis- b12 deficiency
angular stomatitis- iron deficiency anaemia
aphthous ulcers- crohns disease
oral candidiasis

Question 6

what do you check in the neck?

Answer 6

lymph nodes

esp virchows node in the left supraclavicular fossa- it is associated with GI mallignancy

Question 7

what do you check for on the chest?

Answer 7

• > 5 spidernaevi

- gynaecomastia- hepatic disease causes high estrogen

Question 8

what do you need to make sure to do when you are examining the tummy?

Answer 8

• lie the patient flat on the bed

Question 9

what should you look for on inspection of the abdomen?

Answer 9

• hernias- ask patient to cough
• distention
• scars
• stomas
• pulsation

Question 10

how should you check for organomegaly?

Answer 10

liver:
due to hepatocellular carcinoma, hepatitis, congestive heart failure, cirrhosis
RIF–> right costal margin

spleen:
portal hypertention, congestive heart failure, myelofibrosis
RIF–> left costal margin

Question 11

what else do you need to do as part of palpation of the abdomen apart from check for organomegally?

Answer 11

• push on either side for AAA
• percuss for the liver- from RIF upwards
• Percuss the splenic border- from RIF to left costal margin
• percuss umbilical region to suprapubic region to check for urinary retention

ask if they would like you to check for shifting dullness

Question 12

where should you auscultate the abdomen?

Answer 12

• check for normal bowel sounds
• listen for aortic bruit 1cm above umbilicus
• listen for renal bruit 1cm lateral to umbilicus

Question 13

what should you check for in the ankles?

Answer 13

ankle odema