Furring of the tongue and bad breath could be
Intra abdominal sepsis
Eg peritonitis , appendicitis
Lack of abdominal wall movement in respiration
Peritonitis
Rebound tenderness is?
Found in
Pain when abdomen released rapidly after compression
Peritonitis
Signs of toxicity and sepsis
6 Ts Tachycardia Tachypnoea Tremors Toxic look Tiredness Temperature
Causes of acute pancreatitis
GET SMASHD Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion Hyperlipidaemia Drugs - azathiopine, diuretics
Pallor or palmar creases
Anaemia
GI causes of clubbing
Cirrhosis , ulcerative colitis, crohns , coeliac disease
Leukonychia is?
Seen in ?
White patches in nails
If affects all nail beds may be –> chemo
Terry’s nails (leukonychia totalis) found in?
Hypoalbuminaemia
(Nephrotic syndrome, liver failure, protein malabsorption
Spoon shaped nails called?
Seen in ?
Koilonchyia
Chronic iron deficiency
What are spider naevi ?
Found in?
Where are they usually seen
Single arteriolar with radiating dilated capillaries
Seen in 20% healthy people
Lots seen in liver disease with circulating oestrogens
Upper trunk head neck and arms
What is dupuytrens contracture
Fibrosis and shortening of palmar aponeurosis
When is liver flap seen?
Why?
Where else (other system)
Coarse flapping tremor –> liver failure with failure of ammonia metabolism to urea
Also seen in renal failure and respiratory failure with CO2 retention
What is Xanthelasma ?
Seen in
Yellowish deposit of fat around eyelids
Hyper cholesterol
What is corneal Arcus ?
Seen in?
White /pale ring around iris
Hypercholesterol
What does telangiectasia look like?
Where does it affect ?
Issue?
Little red dots on lips/ oral mucosa
Face, oral mucosa, GI tract, lungs, liver, brain
Haemorrhage
Angular stomatitis caused by?
Deficiency of b12,6 folate or iron
What is glossitis?
Seen in? When is it painful ?
Smooth red tongue
Painful - b12/folate deficiency
Painless - iron deficiency
Ulcers in oral mucosa
B12 deficiency , iron deficiency, crohns , coeliac
Cause of gynaecomastia
Increased circulating oestrogens in liver failure
What is troisiers sign
Enlargers left supra clavichord lymph node (virchows)
Metastisis form intraabdominal malignancy
Distended veins in abdomen ?
Inferior vena cava obstruction
Portal hypertension
5 Fs of abdominal distension
Fluid Faeces Flat us Foetus Fat
What is courvoisier’s law
In the presence of a palpable gall bladder, jaundice is NOT likely to be due to gallstones
Bowel sounds in obstruction
Tinkling
4 questions for scrotal swellings
Can you get above the swelling
Can the testis and epididymis be identified separately
Does the swelling transilluminate
Is the swelling tender
Jaundice and abdominal pain is usually?
Gallstones
Eg causes of clubbing
IBD, cirrhosis, coeliac
What is spooning of nails called?
Cause
Koilonychia
Chronic iron deficiency
Whitened nail bed called?
Cause
Leukonychia
Hypoalbuminaemia ( liver failure / enteropathy)
Palmar erythema looks like?
Cause?
Reddening of palms
Liver disease / pregnancy
Dupuytrens contracture associated with
Alcohol excess
3 causes of liver flap
Liver failure
Uraemia
Co2 retention
Bruising may suggest
^PT due to liver failure
What do petachiae suggest
Thrombocytopenia (platelets
Excoriations are?
Possible cause?
Raw irritated lesion (maybe scratching )
Iron deficiency anaemia / cholestasis
Tract marks on arms indicate
IV drug use - risk for hepatitis B/C
Axillary hair loss could mean
Malnourishment
Iron deficient anaemia
What is acanthosis nigricans ?
Indicative of
Darkened pigmentation of axillary
Malignancy im GI tract
Cause of angular stromatitis
Iron / b12 deficiency
What is oral candidiasis ?
Causes ?
White Slough noticed on mucous membranes
Iron / immunodeficiency
Mouth ulcers cause
Crohns
Coeliac
Glossitis looks like?
Cause ?
Smooth red swollen tongue
Iron/b12/folate deficiency
Where is virchows node?
Indicative of?
Left supraclavicular fossa
Gastric malignancy
Spider naevi look like
How many to be significant?
Cause ?
Central red spot with reddish extensions
Cause of gynaecomastia
Liver cirrhosis
Digoxin
Spironolactone
Hair loss indicative of
Malnourishment
Iron deficiency anaemia
Midline scar
RIF scar
RSC scar
Laparotomy
Appendectomy
Cholecystectomy
What is Cullen’s sign ?
Causes?
Bruising surrounding umbilicus
Retro peritoneal bleed (pancreatitis / ruptured AAA)
Grey turners sign ?
Causes?
Flank bruising
Retro peritoneal bleed ( pancreatitis / ruptured AAA)
5 fs of abdominal distension
Fluid, fat, faeces, flatus, fetus
Abdominal striae cause? Colours mean?
Abdominal distension
Reddish (new) silver (chronic)
What is caput medusae ?
Cause
Engorged para umbilical veins
Portal hypertension
Colostomy vs ileostomy locations
Colon - LIF
Ileostomy - RIF
Cause of a pulsatile enlarged liver
Tricuspid regurgitation
Enlarged gall bladder suggests
Obstruction / infection (cholecystitis)
Murphys sign indicates
Cholecystitis
How much bigger does a spleen have to be to be palpated
3x
Abdominal bowel sounds
Normal - gurgling
Abnormal - tinkling (obstruction)
Absent - ileus / peritonitis
Where listen for abdominal Bruis
Aortic - just above umbilicus
Renal - just above and slightly lateral
