Abdominal Examination

Question 1

What can cause palmar erythema?

Answer 1

Chronic liver disease
+
Normal finding in pregnancy

Question 2

What is Koilonychia?

Answer 2

Spoon-shaped nails

Question 3

What is Leukonychia?

Answer 3

Whitening of the nail bed

Question 4

What causes Koilonychia?

Answer 4

Iron deficiency anaemia e.g. malabsorption in Crohn’s

Question 5

What causes Leukonychia?

Answer 5

Hypoalbuminaemia e.g. from end stage liver disease, or protein-losing nephropathy

Question 6

What are the causes of clubbing in abdo exam?

Answer 6

1. IBD
2. Coeliac disease
3. Liver cirrhosis
4. Lymphoma of the GI tract

Question 7

How long do the arms need to be out to check for asterixis?

Answer 7

30 seconds

Question 8

What are the possible causes of asterixis?

Answer 8

1. Heptatic encephalopathy (due to hyperammonaemia)
2. Uraemia secondary to renal failure
3. Co2 retention secondary type 2 resp failure

Question 9

What is Dupuytren’s contracture?

Answer 9

Thickening of the palmar fascia

Question 10

What are the RF for developing Dupuytren’s contracture?

Answer 10

Genetics 
Excessive alcohol use 
Increasing age 
Male gender
Diabetes

Question 11

What is acanthosis nigricans?

Answer 11

Darkening (hyperpigmentation) and thickening (hyperkaratosis) of the axillary skin

Question 12

What is associated with acanthosis nigricans?

Answer 12

Benign (in dark-skinned people
Insulin resistance (T2DM) 
GI malignancy (most commonly stomach cancer)

Question 13

What causes axillary hair loss?

Answer 13

Iron deficiency anaemia

Malnutrition

Question 14

What can angular stomatitis mean in abdo exam?

Answer 14

GI malignancy

Malabsorption

Question 15

What causes glossitis?

Answer 15

Iron deficiency
B12 deficiency
Folate deficiency
e.g. from malabsorption secondary to IBD

Question 16

What are aphthous ulcers?

Answer 16

round or oval ulcers on the mucous membranes inside the mouth

Question 17

What causes aphthous ulcers?

Answer 17

1. benign e.g. due to stress or mechanical trauma
2. iron, b12, folate def
3. Crohn’s disease

Question 18

What is the importance of Virchow’s node?

Answer 18

It receives lymphatic drainage from the abdominal cavity and therefore is one of the first clinical signs of metastatic intra-abdominal malignancy (most commonly gastric cancer)

Question 19

Where is Virchow’s node?

Answer 19

Left supraclavicular fossa

Question 20

What is the importance of the right supraclavicular lymph node in abdo exam?

Answer 20

It receives lymphatic drainage from the thorax and so can indicate metastatic oesophageal cancer

Question 21

What causes spider naevi?

Answer 21

high circulating levels of oestrogen (same for gynaecomastia)

• Liver cirrhosis
• normal finding in pregnacy
• COCP

Question 22

How many spider naevi are need to be more inclined to a pathological cause such as liver cirrhosis?

Answer 22

> 5

Question 23

What medications cause gynaecomastia?

Answer 23

Spironolactone

Digoxin

Question 24

What is Cullen’s sign?

Answer 24

Bruising of the tissue surrounding the umbilicus associated with haemorrhagic pancreatitis

Question 25

What is Grey tuner's sign?

Answer 25

bruising in the flanks assocaited with haemorrhagic pancreatitis

Question 26

If a stoma is present what should you assess?

Answer 26

1. Location 2. Contents 3. Consistency of stool 4. Spout r

Question 27

What is rebound tenderness?

Answer 27

When you press down slowly but release rapidly, you get pain

Question 28

What is rebound tenderness associated with?

Answer 28

Peritonitis e.g. appendicitis

Question 29

What is guarding?

Answer 29

Involuntary tension inthe abdo muscles on palpation

Question 30

What is guarding associated with?

Answer 30

Peritonitis e.g. appendicitis and diverticulitis

Question 31

What is Rovsing's sign?

Answer 31

Palpation of the LIF causes pain on the RIF

Question 32

If a mass is found on deep palpation what characteristics should you assess?

Answer 32

``` Location Size and shape Consistency Mobility Pulsatiliy (vascular pathology e.g. AAA) ```

Question 33

What are causes of hepatomegaly?

Answer 33

Hepatitis Malignancy: HCC or mets PBC Metabolic: Wilsons and haemochromatosis

Question 34

How do you elicit Murphy's sign?

Answer 34

Position fingers at the right costal margin in the mid-clavicular line at the liver's edge and ask the patient to take a deep breath in - if the patient suddenly stops mid-breath due to pain - then it is positive

Question 35

What does Murphy's sign detect?

Answer 35

Cholecystitis

Question 36

What are the causes of splenomegaly?

Answer 36

1. Portal HTN secondary to liver cirrhosis 2. Haemolytic anaemia 3. Congestive HF 4. Splenic metastases 5. Glandular fever

Question 37

What are causes of enlarged kidneys?

Answer 37

``` Bilateral 1. PKD 2. Amyloidosis Unilateral 1. Renal tumour ```

Question 38

When you palpate the aorta how should your hands move in healthy individuals and how do they move in AAA?

Answer 38

Healthy - superiorly (upwards towards the head) | AAA - they move outwards - it is an expansile mass

Question 39

What 3 types of bowel sounds are there?

Answer 39

Normal Tinkling Absent

Question 40

What does tinkling vs absent bowel sounds suggest?

Answer 40

``` Tinkling = osbtruction Absent = ileus (loss of peristaltic motion of the bowel) ```

Question 41

What are causes of ileus?

Answer 41

Electrolyte abnormalities | Recent abdo surgery

Question 42

How long do you need to assess for to conclude absent bowel sounds?

Answer 42

3 minutes

Question 43

How do you complete an abdo exam?

Answer 43

1. Check Hernial orifices (if there are signs of bowel obstruction) 2. DRE (if suspect GI bleeding) 3. Examine the external genitalia

Question 44

Why do you examine the external genitalia in abdo exam?

Answer 44

To rule out testicular torsion which can be referred abdo pain To rule out Indirect inguinal hernia