Examination of the abdomen

6 Examination of the abdomen





Questions



image What are the hand signs of chronic liver disease?

image What are the methods for assessing ascites?

image What are the differences between a kidney and the spleen?

Certain cases might be expected to be in an OSCE: chronic liver disease, hepatomegaly, splenomegaly, hepatosplenomegaly, ascites, stomas, scars (fresh or old), drains, and past dialysis.




Introduction


Any examination must follow the initial steps of introduction, obtaining consent and then exposing the relevant area. The patient should be asked about any pain. A student would then indicate the area to be examined, such as ‘I would like to expose the patient from nipples to knees’. The examiner may ask for just the abdomen to be exposed.



Inspection




General inspection


This starts from the end of the bed: anaemia, jaundice, cyanosis, pain, distressed, shortness of breath, raised jugular venous pressure. Obvious abdominal signs are scars, drains, stomas, distension, wasting, drips, feeding (enteral with nasogastric tubes or gastrostomy, or parenteral via central line). Obvious hernias are revealed if the patient coughs.



Hands


The hands can indicate a number of conditions


image clubbing: chronic liver diseases (cirrhosis); also indicative of gastrointestinal lymphoma and inflammatory bowel disease

image leukonychia: white nails (hypoalbuminaemia)

image koilonychia: spooned nails (iron-deficient anaemia)

image spider naevi: a dilated arteriole surrounded by capillaries that blanches and reappears when pressed; it is thought to be caused by oestrogen excess (the liver normally metabolizes oestrogen, and so liver damage reduces oestrogen removal) and occurs in the distribution of the superior vena cava (arms, face and chest above umbilicus); a normal adult may have up to five

image palmar erythema: reddening of the palms (of uncertain cause: it is seen in liver disease, rheumatoid arthritis, pregnancy, regional ileitis, some skin diseases)

image Dupuytren’s contracture

image liver flap: arms straight with hands extended back (caused by hepatic encephalopathy).


Eyes


Signs of jaundice (yellow sclera), anaemia (pale conjunctivae), xanthalasmia, corneal arcus (hyperlipidaemia) may be seen.

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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Examination of the abdomen

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