Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
OSCE Prep 7
Abdominal Examination
| mixed | mixed |
|---|---|
| What are the GI causes of clubbing? | MILC Malabsorption (eg coeliac) Inflammatory bowel disease (UC+Crohn's) Lymphoma Cirrhosis |
| When does asterixis happen? What is its other name? | Coarse flapping tremor - Occurs with hepatic encephalopathy |
| What is leukonychia and what is it associated with? | Whitening of the nail bed, assocaited with hypoalbuminaemia (eg- end stage liver disease, protein-losing enteropathy) |
| What is koilonychia associated with in GI? | associated with iron deficiency anaemia (e.g. malabsorption in Crohn’s disease). |
| What is palmar erythema and what is it associated with? | a redness involving the heel of the palm that can be associated with chronic liver disease (it can also be a normal finding in pregnancy). |
| What is dupuytren's contracture? How to acc pronounce this? | involves thickening of the palmar fascia, resulting in the development of cords of palmar fascia which eventually cause contracture deformities of the fingers and thumb. |
| What is Dupuytren's contracture associated with? GI and other things | genetics, EXCESSIVE ALCOHOL USE, increasing age, male gender and DIABETES. |
| What is spider naevus? naevi? | skin lesions that have a central red papule with fine red lines extending radially caused by increased levels of circulating oestrogen. |
| What are spider naevi associated wth? | Spider naevi are commonly associated with liver cirrhosis, but can also be a normal finding in pregnancy or in women taking the combined oral contraceptive pill. |
| How many spider naevi might flag a concern? | If more than 5 are present it is more likely to be associated with pathology such as liver cirrhosis. |
| What is the inflammation of small blood vessels cause on inspection? | Purpura (rash) |
| What is jaundice and what is the physiological reason behind it? What are the causes? | a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels (e.g. acute hepatitis, liver cirrhosis, cholangitis, pancreatic cancer). |
| What does conjunctival pallor suggest? | Underlying anaemia |
| What are you looking for in the mouth? | Stomatitis, glossitis, candidiasis, ulcers, pigmentation (Peutz- Jeghers Syndrome - v. rare), telangiectasia, dentition, gingivitis and “mousy” odour (fetor hepaticus |
| What is another name for candidiasis? | oral thrush |
| What are you inspecting in chest and axillae? | Inspect chest for spider naevi, gynaecomastia in men, and both axillae for loss of axillary body hair |
| What are you looking for in the close inspection of abdomen? | Movement, distension, scars, herniae, masses, striae, dilated veins “caput medusae” |
| What is caput medusae and what is it associated with? What might cause it? | engorged paraumbilical veins associated with portal hypertension (e.g. liver cirrhosis). |
| How to check for hernias? | ask the patient to cough and observe for any protrusions through the abdominal wall (e.g. umbilical hernia, incisional hernia). |
| What is Cullen's sign? What is it associated with and what might cause it? | bruising of the tissue surrounding the umbilicus associated with haemorrhagic pancreatitis (a late sign). |
| What is Grey-Turner's sign? Associated w and causes? | bruising in the flanks associated with haemorrhagic pancreatitis (a late sign). |
| What are the 5 Fs of distension? | Fat, Fluid, Faeces, Flatus, Foetus |
| What are the names of the 9 regions in abdomen? | R L hypochondriac region R L lumbar region R L iliac region (Iliac fossa) Epigastric Umbilical Hypogastric (suprapubic) |
| What are the four quadrant? | Upper R L Lower R L |
| What are we palpating for in the abdomen? | – Tenderness (including guarding or re-bound tenderness) / masses / organomegaly (liver, spleen, kidneys) / abdominal aorta |
| What is important for palpation? | Look at the patients face |
| What are the causes of hepatomegaly? | Hepatitis Alcoholic liver disease Right heart failure Fatty infiltration Biliary tract obstruction Malignancy (metastatic / primary) Haematological disorders |
| What is Murphy's sign? Where to palpate? What are causes | • Feel for gall bladder tenderness (e.g. acute cholecystitis) • Patient breathes in whilst you gently palpate RUQ in midclavicular line • On liver descent contact with inflamed gallbladder causes tenderness and sudden arrest of inspiration |
| What is Courvoisier's sign? What causes it? What not? | • Painless jaundice and a palpable gallbladder • Likely due to extrahepatic obstruction • E.g. Pancreatic cancer • UNLIKELY to be gallstones |
| How to palpate for splenomegaly? | Spleen moves with respiration Ask the patient to breathe in and out deeply Palpate upwards to left hypochondrium Feel for edge of an enlarged spleen as it descends on inspiration |
| What are the main types of causes of splenomegaly? | -Haematological -Infective -Portal hypertension -Rheumatological disorders -Rare causes |
| Haematological causes of splenomegaly? | - Haemolytic anaemias / Leukaemias / Polycythaemia rubra vera / Lymphoma /myeloproliferative diseases / myelofibrosis |
| Infective causes of splenomegaly? | infectious mononucleosis, infective endocarditis, TB, malaria |
| Rheumatological disorder scauses of splenomegaly? | rheumatoid arthritis (Felty’s syndrome) / SLE |
| Rarecauses of splenomegaly? | sarcoidosis / amyloidosis / glycogen storage diseases |
| What are the causes of renal enlargement | • Hydronephrosis • Polycystic kidney disease • Renal cell carcinoma • In children, nephroblastoma (Wilm's tumour) • Solitary cysts |
| What type of aortic aneurysm is the most common type? | Abdominal |
| Where do we percuss in the abdomen | Liver, spleen and bladder |
| What is ascites? How do w pick it up? | Abnormal collection of fluid in peritoneal cavity Percussion if dull! Shifting dullnes and fluid thrill(?) |
| What are the causes of ascites? | – Hepatic cirrhosis – Intra-abdominal malignancy – Nephrotic syndrome – Cardiac failure – Pancreatitis – Constrictive pericarditis etc |
| What do we auscultate in diaphragm and abdomen? | Listen for normal bowel sounds (up to 2 min) Auscultate for abdominal aortic bruits Auscultate renal arteries |
| What are aortic bruits associated w? | Abdominal aortic aneurysm |
| What are renal bruits associated with? | renal artery stenosis |
| where might tumours of the upper gastrointestinal tract may metastasise to? | to the lower part of the left posterior cervical triangle: – Virchow’s node / Troisier’s sig |
| What else to offer in abdo exam? | • Offers to examine groin • Offers to examine genitalia • Requests to do digital rectal examination (DRE |
Created by:
Mustafak