Abdominal Examination

Question 1

What can be looked for in abdominal examination during general inspection?

Answer 1

Patient: well/unwell, pain/discomfort, jaundice, pallor, muscle wasting, cachexia

around bed: vomit bowels, IV infusions, nutrition, catheter

Question 2

what can be seen in the hands during examination in a abdominal exam

Answer 2

flapping tremor

nails: clubbing, leukonychia, koilonychia

palms: palmar erythema, Dupuytren’s contracture, fingertip capillary glucose marks

Question 3

what may cause clubbing?

Answer 3

IBD

cirrhosis

coeliac disease

Question 4

what may cause leukonychia

Answer 4

hypoalbuminemia in liver cirrhosis/ enteropathy

Question 5

what may cause kolionychia?

Answer 5

iron deficiency

Question 6

what may cause palmar erythema

Answer 6

hyperdynamic circulation due to increased oestrogen levels in liver disease/pregnancy

Question 7

what may cause duppuytren’s contracture?

Answer 7

can be related to alcoholism or liver disease

Question 8

why might a patient have fingertip capillary glucose monitoring marks?

Answer 8

diabetes

Question 9

how do you demonstrate a flapping tremor?

Answer 9

patient hold arms out straight with wrists cocked back

Question 10

what may cause a flapping tremor?

Answer 10

hepatic encephalopathy

Question 11

what should be checked in a face examination in an abdominal exam?

Answer 11

eyes

mouth

Question 12

what may be seen in eyes in a face exam in an abdominal exam?

Answer 12

sclera for jaundice

conjunctival pallor

periorbital xanthelasma

Question 13

when might a patient have scleral jaundice?

Answer 13

liver disease

Question 14

what is the cause of conjunctival pallor?

Answer 14

anaemia- GI bleed, malabsorption etc

Question 15

what is periorbital xanthelasma caused by?

Answer 15

hyperlipidaemia in cholestasis

Question 16

what should be checked for in the mouth in abdominal examinations?

Answer 16

glossitis/stomatitis

aphthous ulcers

breath odour

Question 17

what may cause glossitis/ stomatitis?

Answer 17

iron/ vit B12 deficiency

Question 18

what may cause aphthous ulcers?

Answer 18

IBD

Question 19

what may cause a feculent breath odour?

Answer 19

obstruction

Question 20

what may cause a fruity breath odour?

Answer 20

ketoacidosis

Question 21

what may cause a fetor hepaticus/sweet breath odour?

Answer 21

portal hypertension

Question 22

what are the odours that should be checked for in the mouth?

Answer 22

feculent

fruity

sweet/ fetor hepaticus

alcohol odour

Question 23

what lymph node is most important to check?

Answer 23

left supraclavicular fossa- virchow’s node

Question 24

what is virchow’s node a sign of?

Answer 24

gastric malignancy

Question 25

when are spide naevi signigicant?

Answer 25

\>5

Question 26

when might skin lesions be seen on a back?

Answer 26

immunosuppresison

Question 27

what should be check on chest inspection?

Answer 27

spider naevi gynacomastia loss of axillary hair loss

Question 28

what may cause spider naevi, gynecomastia and loss of peripheral hair loss?

Answer 28

all caused by increased oestrogen liver disease or pregnancy

Question 29

what are the causes of abdominal distention?

Answer 29

Fat fluid flatus fetus faeces

Question 30

what may cause Striae?

Answer 30

pregnancy cushing's disease

Question 31

what causes caput medusae?

Answer 31

portal hypertension

Question 32

what should be checked on abdominal examination?

Answer 32

scars distention spider naevi hernias movement with respiration obvious pulsations distended abdominal wall veins stomas

Question 33

when is abdominal wall movement on respiration absent?

Answer 33

peritonitis

Question 34

what should be asked before starting palpation?

Answer 34

any pain- start away from painful areas

Question 35

what is the order of palpation of abdomen?

Answer 35

superficial deep liver spleen kidney aorta

Question 36

when is rovsing's sign seen?

Answer 36

appendicitis

Question 37

when in murphy's sign seen?

Answer 37

cholecystitis

Question 38

what may hepatomegaly be caused by?

Answer 38

metastasis/ hepatocellular carcinoma heppatitis RVF leukaemia/lymphoma fatty liver alcoholic liver disease

Question 39

what may cause splenomegaly?

Answer 39

lymphoma/ leukaemia myelofibrosis myeloproliferative disorders portal hypertension extravascular haemolysis malaria/ EBV

Question 40

what is the difference between spleen and kidney palpation?

Answer 40

cannot get above spleen spleen notched spleen not ballotable spleen moves down on inspiration

Question 41

what does a pulsatile, expansile mass on abdominal aorta palpation suggest?

Answer 41

AAA