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What are the GI causes of clubbing?
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When does asterixis happen? What is its other name?
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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