Abdominal Examination

Question 1

The GIT system comprises of?

Answer 1

1. alimentary tract,
2. liver,
3. biliary system,
4. pancreas
5. spleen

Question 2

The alimentary tract comprises of?

Answer 2

Extends from the mouth to the anus and includes
the
1. oesophagus,
2. stomach,
3. small intestine or small bowel (duodenum, jejunum and
ileum),
4. colon (large intestine or large bowel)
5. rectum.

Question 3

Positioning of a patient?

Answer 3

1. Examine the patient in good light and warm surroundings,
2. Supine with the head resting on only one or two pillows to relax the
   abdominal wall muscles.
3. Use extra pillows to support a patient with kyphosis or
   breathlessness.

Question 4

Examination sequence?

Answer 4

1. Introduction and explanation!
2. Inspection
3. Palpation
4. Percussion
5. Auscultation

Question 5

Inspection?

Answer 5

1. Step back!
   * Look around the patient
   * Drains / medication / fluids / vomit bowl / tubes
2. Expose – ‘knee to nipple’?
3. Look at the patient
   - Note general appearance and level of Discomfort
4. Ask them to point to site of pain
   - Note the position assumed by the patient when in pain

Question 6

What are you looking for upon general inspection of patient?

Answer 6

1. distension,
2. yellow
3. muscle wasting
4. scratch marks
5. spider naevi
6. purpura,
7. oedema
8. tattoos

Question 7

What is spider naevi?

Answer 7

dilated small blood vessels of skin (telangiectases) that consist of a centerally dilated arteriole from which numerous small vessels radiate resembling a spiders legs
- sign of hepatocellular failure

Question 8

Clinical association of spider naevi?

Answer 8

1. cirrhosis of liver - especially alcoholics
2. viral hepatitis (transient)
3. 3rd trimester of pregnancy
4. sometimes in thyrotoxicosis
5. oestrogen therapy

Question 9

What is purpura?

Answer 9

a rash of purple spots due to small blood vessels leaking blood into the skin, joints, intestines or organs

Question 10

Inspection of hands?

Answer 10

1. finger clubbing
2. leuconychia
3. koilonychia
4. palmar erythema
5. Dupyterns contracture
6. spider naevus
7. pupurae

Question 11

Finger clubbing?

Answer 11

abnormal rounded shape of the nail bed
- causes by chronic low blood oxygen levels

Question 12

Finger clubbing test?

Answer 12

Schamroth window test
- if 2 opposing fingers are held back to back against each other a diamond shaped space should normally appear between the nail beds and the nails of the 2 fingers
> in clubbing this space is missing

Question 13

GI causes of finger clubbing?

Answer 13

1. Cirrhosis
2. Ulcerative Colitis
3. Crohn’s disease
4. Coeliac disease

Question 14

CVS causes of clubbing?

Answer 14

1. infective endocarditis
2. cyanotic congenital heart disease
   - result in a low blood oxygen level
3. atrial myxoma
   - tumour in the atria of the heart

Question 15

Respiratory causes of clubbing?

Answer 15

1. lung cancer
   - except small cell
2. chronic suppurative lung disease
   - cystic fibrosis, bronchiectasis, lung abscess, empyema
3. pulmonary fibrosis
4. NOT COPD

Question 16

Other causes of clubbing?

Answer 16

1. thyrotoxicosis (thyroid acropathy)
2. hereditary

Question 17

Other causes of clubbing?

Answer 17

1. thyrotoxicosis (thyroid acropathy)
2. hereditary

Question 18

What is leuconychia?

Answer 18

white discolouration appearing on nails

Question 19

Causes of leuconychia?

Answer 19

1. nail bed injury
2. mineral deficiency
   - zinc, calcium
3. iron deficiency anemia
4. chronic renal disease
5. hypoalbuminemia
6. liver cirrhosis

Question 20

Koilonychia?

Answer 20

soft nails that look scooped out

Question 21

Causes of koilonychia?

Answer 21

iron deficiency anemia
1. malnutrition
2. worms
3. celiac disease
4. GI blood loss
5. malignancy

Question 22

Palmar erythema?

Answer 22

skin condition that makes the palms of your hands turn red

Question 23

Causes of palmar erythema?

Question 24

Dupytrens contracture?

Answer 24

gradual thickening and tightening of tissue under the skin in the hand
- most often affects the 4th (ring) and 5th (little) fingers

Question 25

Causes of Dupytrens contracture?

Question 26

Inspection of eyes?

Answer 26

1. Look DOWN for jaundice: - Inspect sclera 2. Look UP for anaemia: - Inspect lower eyelid conjunctiva

Question 27

What to look for in inspecting the mouth?

Answer 27

Mouth / breath / lips / tongue / teeth / gums 1. Stomatitis 2. glossitis 3. candidias 4. ulcers 5. pigmentation (Peutz- Jegers Syndrome - v. rare) 6. telangiectasia, 7. dentition 8. gingivitis 9. odours 10. KS lesions

Question 28

Glossitis?

Answer 28

inflammation of the tongue - change in tongue texture and colour - swelling and tenderness - loss of papillae

Question 29

Causes of glossitis?

Answer 29

1. benign conditions 2. nutriotional deficiency - iron deficiency anemia - B12 deficiency 3. infections - oral herpes - candida 4. allergies 5. autoimmune conditions - celiac disease - Sjorgen syndrome 6. mouth injuries

Question 30

What is oral candidiasis?

Answer 30

infection in which the fungus Candida albicans accumulates in the mouth

Question 31

What is angular stomatitis?

Answer 31

inflammation and small cracks in one or both corners of the mouth

Question 32

What are karposi sarcoma lesions?

Answer 32

kaposi sarcoma causes lesions to grow in in skin, lymph nodes and internal organs amd mucous membranes lining the mouth nose and throat - affects people that are immunocompromised e.g. HIV/AIDS

Question 33

Cervical lymph node exam?

Answer 33

1. May indicate local disease 2. May indicate more distant disease: - Tumours of the upper gastrointestinal tract may metastasise to the lower part of the left posterior cervical triangle - Nodes in supraclavicular fossa

Question 34

Chest inspection?

Answer 34

1. Gynaecomastia and loss of axillary hair in men may be evidence of chronic liver disease 2. breast atrophy in women

Question 35

Abdominal inspection?

Answer 35

1. Expose abdomen - Lie flat with one pillow. 2. Movement, distension, scars, herniae, masses, striae (similar to stretch marks), dilated veins 3. Distension - Fat, Fluid, Faeces, Flatus, Foetus

Question 36

Abdominal surgical scars?

Answer 36

1. Mercedes benz 2. right sub costal (Kochers) 3. right paramedian 4. appendicentomy 5. suprapubic 6. inguinal 7. upper/lower midline

Question 37

Abdominal palpation?

Answer 37

Start away from any area of pain -watch the patient’s face!! - Superficial, then deep palpation: 1. Position yourself at patient’s level by sitting, kneeling or squating 2. Feel with whole hand 3. Flex at MCP joint

Question 38

What are we palpating for?

Answer 38

1. Tenderness - including guarding or re-bound tenderness) 2. masses 3. organomegaly (liver, spleen, kidneys) 4. abdominal aorta

Question 39

Inspection of the liver?

Answer 39

1. Liver moves with respiration 2. Begin in right iliac fossa 3. Ask the patient to breathe in and out deeply 4. Palpate upwards to right costal margin 5. Feel for liver edge

Question 40

Inspection of hepatomegaly?

Answer 40

- Smooth / nodular / generalised or focal enlargement - Associated symptoms (e.g. jaundice)

Question 41

Causes of hepatomegaly?

Answer 41

1. Hepatitis 2. Alcoholic liver disease 3. Right heart failure 4. Fatty infiltration 5. Biliary tract obstruction 6. Malignancy (metastatic / primary) etc

Question 42

Inspection of the spleen?

Answer 42

1. Spleen moves with respiration 2. Begin in right iliac fossa 3. Ask the patient to breathe in and out deeply 4. Palpate upwards to left hypochondrium 5. Feel for edge of an enlarged spleen

Question 43

Causes of splenomegaly?

Answer 43

1. Haematological - Haemolytic anaemias / Leukaemias / Polycythaemia rubra vera / Lymphoma / essential thrombocythaemia / myelofibrosis 2. Infective (e.g. infectious mononucleosis, infective endocarditis, TB, malaria) 3. Congestive splenomegaly - Liver cirrhosis / portal or splenic vein obstruction / Portal hypertension 4. Abscess / metastases / tumours Note: May be up to 3 times normal size before being palpable

Question 44

Technique for renal enlargement?

Answer 44

2 handed technique to ballot the kidneys

Question 45

Causes of renal palpation?

Answer 45

1. Hydronephrosis 2. Polycystic kidney disease 3. Renal cell carcinoma 4. In children, nephroblastoma (Wilm's tumour) 5. Solitary cysts

Question 46

What is percussion?

Answer 46

The percussing finger is the middle finger of your right hand. * Fluid, relaxed flexion of right wrist joint * Volume is increased by pushing harder on the abdomen / chest with the percussed middle finger of your left hand * Differentiates air filled spaces (resonant) from fluid or solid filled (dull)