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Year 3 CCA > Abdominal Examination > Flashcards

Abdominal Examination Flashcards

1
Q

What level of exposure is adequate for an abdominal examination?

A

Xiphisternum to pubic symphysis

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2
Q

What are you looking for in the surrounding area?

A
  1. Drips
  2. Oxygen
  3. Drains/ stomas
  4. Vomit bowel
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3
Q

What are you looking for on general inspection of the patient?

A
  1. Body habitus
  2. Well/ unwell
  3. Pain
  4. Fever
  5. Jaundice
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4
Q

What are you looking for when inspecting the nails?

A
  1. Clubbing
  2. Leuconychia
  3. Koilonychia
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5
Q

What is clubbing and what might it indicate (abdo related)?

A

Clubbing is the loss of the nail bed angle.

May be seen in:

  1. IBD
  2. Cirrhosis
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6
Q

What is leuconychia and what might it indicate?

A

Leuconychia is whitening of the nail beds due to low albumin.

May be seen in:

  1. Malnutrition
  2. Malabsorption
  3. Chronic liver disease
  4. Nephrotic syndrome
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7
Q

What is koilonychia and what might it indicate?

A

Koilonychia is the spooining of the nails.

May be seen in:
1. Iron deficiency (congenital or chronic)

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8
Q

What are you looking for when inspecting the hands?

A
  1. Xanthomata
  2. Dupuytren’s contracture
  3. Palmar erythema
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9
Q

What is xanthomata and what might it indicate?

A

Xanthomata are raised yellow lesions on tendons.

May be seen in:
1. Hyperlipidaemia through primary biliary cirrhosis

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10
Q

What is Dupuytren’s contracture and what might it indicate?

A

Dupuytren’s contracture is the thickening and contracture of palmar fascia.

May be seen in:

  1. Alcoholic liver disease
  2. Manual work
  3. Familial
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11
Q

What is palmar erythema and what might it indicate?

A

Palmar erythema is the blotchy reddening of the palms (due to increase in circulating oestrogen).

May be seen in:

  1. Chronic liver disease
  2. Pregnancy
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12
Q

What are you looking for when inspecting the wrists and arms?

A
  1. Pulse (being aware of AV fistula)
  2. Flapping tremor
  3. Brusing
  4. Scratch marks
  5. Track marks and tattoos
  6. Dermatitis Herpeteformis
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13
Q

How do you test for flapping tremor? What might it indicate?

A

Arms straight out in front, wrists cocked back, fingers spread for >15 secs. Look for jerky, irregular flexion/ extension (may be subtle).

May indicate:
1. Encephalopathy due to liver failure

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14
Q

What might bruising indicate?

A

Chronic liver disease (as may affect clotting)

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15
Q

What might scratch marks indicate?

A

Raised urea

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16
Q

Why is it important to check for track marks and tattoos?

A

Hepatitis risk

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17
Q

What are you looking for on inspection of the eyes?

A
  1. Yellowing of sclera
  2. Conjunctival pallor
  3. Corneal arcus
  4. Xanthelasma
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18
Q

What does yellowing of the sclera indicate?

A

Jaundice

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19
Q

What does conjunctival pallor indicate?

A

Anaemia

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20
Q

What does corneal arcus and xanthelasma indicate?

A

Hyperlipidaemia

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21
Q

What are you looking for on inspection of the mouth?

A
  1. Angular stomatitis and glossitis
  2. Ulcers (e.g. aphthous)
  3. Foector hepaticus
22
Q

What is angular stomatitis?

A

Reddening and inflammation at the sides of the mouth.

23
Q

What is glossitis?

A

Erythematous swelling of the tongue.

24
Q

What do angular stomatitis and glossitis indicate?

A

Iron, folate and B12 deficiencies.

25
Q

What might mouth ulcers indicate?

A
  1. Coeliac
  2. IBD
  3. Iron deficiency
26
Q

What is foector hepaticus and what might it indicate?

A

Foectus hepaticus is a musty, sweet breath (due to inability to process sulphur).

May be seen in:
1. Liver failure

27
Q

What are you looking for inspection of the chest?

A
  1. Virchow’s node
  2. Gynaecomastia
  3. > 5 spider naevia
28
Q

What is Virchow’s node and what might it indicate?

A

Left supraclavicular swollen node.

May be seen in:
1. Gastric cancer

29
Q

What might gynaecomastia indicate?

A
  1. Alcoholic liver disease

2. Drugs (DISCO: digoxin, isoniazid, spironolactone, cimetidine, oestrogens)

30
Q

What might >5 spider naevi indicate?

A
  1. Chronic liver disease

2. Any other cause of excess oestrogen

31
Q

What are you looking for on inspection of the abdomen?

A
  1. Distension
  2. Everted umbilicus (with distension)
  3. Distended abdominal veins
  4. Hernias
  5. Scars and stomas
32
Q

What are the 6 things that can cause distention?

A
  1. Fat
  2. Fluid
  3. Flatus
  4. Faeces
  5. Foetus
  6. F***ing big mass
33
Q

What might an everted umbilicus with distension indicate?

A

? Ascites

34
Q

What do distended abdominal veins indicate?

A

Portal hypertension

35
Q

What is the term to describe pain as you release?

A

Rebound tenderness

36
Q

What is the term to describe involuntary tension of abdominal muscles?

A

Guarding

37
Q

If you feel an abdominal mass, what should you include in your description of it?

A
  1. Location
  2. Size
  3. Shape
  4. Surface
  5. Consistency
  6. Mobility
  7. Movement (with respiration)
  8. Tenderness
  9. Pulsatile
38
Q

What are causes of hepatomegaly?

A
  1. Alcoholic liver disease
  2. Malignancy (particularly metastases)
  3. Congestive cardiac failure
  4. Hepatitis (viral, drug-induced)
  5. Haemochromatosis
  6. Non-alcoholic fatty liver disease
39
Q

What is Dermatitis Herpeteformis and what is it associated with? How is it treated?

A

Blistering, very itchy skin condition affecting the extensor surfaces.

Associated with Coeliac Disease.

Treated with dapsone and a gluten free diet.

40
Q

What are causes of splenomegaly?

A
  1. Chronic myeloid leukaemia
  2. Mononuceleosis infection
  3. Portal hypertension
  4. Haemolytic anaemias
  5. Sickle Cell Anaemia
41
Q

What are signs of inflammation bowel disease?

A
  1. Aphthous mouth ulcers
  2. Erythema nodosum
  3. Pyoderma gangrenosum
  4. Anal fissures
  5. Surgical scars
  6. Ocular complications (e.g. iritis, uveitis, episcleritis)
  7. Anaemia signs
  8. Nutrition status
42
Q

What is erythema nodosum?

A

Tender, red bumps, usually found symmetrically on the shins.

43
Q

What is pyoderma gangrenosum?

A

Large, painful sores develop on skin (most often legs).

44
Q

What are classical stigmata of chronic liver disease?

A
  1. Spider naevi
  2. Palmar erythema
  3. Jaundice
  4. Hair loss
  5. Leuconychia
  6. Asterixis
  7. Ascites
45
Q

What might a positive Murphy’s sign indicate?

A

Cholecystitis

46
Q

In a situation of a suspected abdominal aortic aneurysm, which side will the pulsatile mass enlarge towards?

A

Enlarges to left side.

47
Q

A mass in the suprapubic area that is dull is most likely what?

A

Bladder

48
Q

A mass in the suprapubic area that is resonant is most likely what?

A

Distended bowel.

49
Q

What do tinkling/ high pitched bowel sounds indicate?

A

Partial or total obstruction.

50
Q

What do loud low pitched (borborygmus) bowel sounds indicate?

A

Diarrhoeal or abnormal peristalsis.

51
Q

What do absent bowel sounds indicate and how long must you listen before declaring absent?

A

Must listen for 2 minutes.

Absent sounds may indicate paralytic ileus or peritonitis.

Year 3 CCA (3 decks)

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