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Abdominal Examination Summary

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Abdominal Examination Summary MEDICAL SUCCESS INSIDERS (MSI) 1 Forewords First of all, thank you for purchasing this book and I am very glad that you have taken your first step to bring your examination techniques and interpretation skill to another advanced level. I can guarantee you that after reading this book, your understanding towards the clinical examination will be deeper and clearer. This book has divided the clinical examination into two main components, mainly the technique part and interpretation of the findings part. And I strongly believe that you need to master both the technique and interpretation skill in order to help you to come to the diagnosis. This book consists of multiple authenticated references and has been arranged into systematic and organized way to ease the study and revision. The book will be updated from time to time in order for you to get the latest updated information and the contents are subject to change. The online softcopy version will be provided too as long as you have bought this book. Last but not least, I hope that this book will be a good companion in your study and career and let us work together towards the goal and achievement. We hope all the best to you. Cheers. -WE CARE, WE SHARE- -Dr. Joseph Chia- Founder of Medical Success Insiders (MSI) © DR. JOSEPH @ WWW.MSIMASTERCLASS.COM ALL RIGHTS RESERVED SIGN UP IN WWW.FRIENDOCT.COM TO ASSESS TO SOFTCOPY 2 MEDICAL SUCCESS INSIDERS (MSI) ABDOMINAL EXAMINATION © DR. JOSEPH @ WWW.MSIMASTERCLASS.COM ALL RIGHTS RESERVED SIGN UP IN WWW.FRIENDOCT.COM TO ASSESS TO SOFTCOPY MEDICAL SUCCESS INSIDERS (MSI) 3 Abdominal Examination Summary: 1. Introduce yourself & wash hand 2. Lie the patient flat with one pillow 3. General Inspection • Age group • Sex • Position • Mental state • Any pain / distress • Build • Nutritional & hydration status • Surroundings à nasal prong / oxygen mask, etc. • Grow chart (paediatrics) • Check temperature 4. Upper Limbs Nails & Fingers: • Pallor / Koilonychia • Clubbing • Leuconychia • Peripheral cyanosis • Temperature Palm: • Palmar erythema • Dupuytren's contracture • Palmar crease • Fine tremor • Coarse / flapping tremor Arms: • Purpura / bruising • Spider nevi • Petechiae • Muscle wasting • Scratch marks Axilla: • Lymphadenopathy • Acanthosis nigricans © DR. JOSEPH @ WWW.MSIMASTERCLASS.COM ALL RIGHTS RESERVED SIGN UP IN WWW.FRIENDOCT.COM TO ASSESS TO SOFTCOPY 4 MEDICAL SUCCESS INSIDERS (MSI) 5. Radial Pulse, Respiratory Rate, Blood Pressure 6. Face Examination Face: • Salivary glands • Telangiectasia Eyes: • Scleral jaundice • Conjunctival pallor • Kayser-Fleischer rings • Iritis • Xanthelasma • Periorbital purpura Tongue: • Coating of tongue • Lingua nigra (black tongue) • Geographical tongue • Leucoplakia • Glossitis • Enlargement of tongue (macroglossia) • Furred tongue • Wasted tongue Teeth: • Decayed tooth Gum: • Gingivitis • Gum hypertrophy Tonsils: • Pigmented lesion in mouth Mouth & Lips: • Angular stomatitis • Pigmented lesion in mouth & lips • Fetor hepaticus • Mouth ulcers • Candidiasis (moniliasis) © DR. JOSEPH @ WWW.MSIMASTERCLASS.COM ALL RIGHTS RESERVED SIGN UP IN WWW.FRIENDOCT.COM TO ASSESS TO SOFTCOPY MEDICAL SUCCESS INSIDERS (MSI) 5 7. Neck Palpation • Virchow's node • Other lymph nodes 8. Chest Examination • Spider nevi • Gynaecomastia • Loss of axillary hair 9. Abdomen Inspection (C.U.S.P2.) • Contour • Umbilicus • Skin • Peristalsis • Pulsation 10. Abdomen Palpation Superficial: • Tenderness / guarding / rebound tenderness / rigidity • Mass / lumps / muscles Deep: • Deeper mass / tenderness • Specific organs examination à liver, spleen, kidneys; gallbladder, stomach, pancreas, bladder, bowel, aorta, appendix, testes • Others à ascites, succussion splash, ventral hernia, abdominal wall mass 11. Abdomen Percussion • Liver span • Spleen • Ascites 12. Abdomen Auscultation • Bowel sound • Bruit • Friction rub • Venous hums 13. Hernia & Groin Examination • Lymphadenopathy • Hernia © DR. JOSEPH @ WWW.MSIMASTERCLASS.COM ALL RIGHTS RESERVED SIGN UP IN WWW.FRIENDOCT.COM TO ASSESS TO SOFTCOPY 6 MEDICAL SUCCESS INSIDERS (MSI) 14. Rectal Examination • Inspection • Palpation • Describe 15. Proctoscopy Examination • Inspection • Palpation • Describe 16. Other Examination • Testing stools for blood • Leg examination • CVS examination • Measurement of temperature • Examination of all lymph nodes groups 17. Wash the hands © DR. JOSEPH @ WWW.MSIMASTERCLASS.COM ALL RIGHTS RESERVED SIGN UP IN WWW.FRIENDOCT.COM TO ASSESS TO SOFTCOPY MEDICAL SUCCESS INSIDERS (MSI) 13 4. Upper Limbs Examination TECHNIQUES Nails & Fingers: Ø Look for nail pallor / koilonychia Ø Check for clubbing Ø Check for leuconychia Ø Look for peripheral cyanosis Ø Feel the temperature Palm: Ø Look for palmar erythema Ø Check for Dupuytren's contracture Ø Look for palmar crease Ø Look for fine tremor Ø Look for coarse / flapping tremor o Ask the patient to hold out / outstretch his arms with hands extended at wrists & fingers spread slightly and demonstrate to the patient o Look for jerky, flapping tremor (asterixis) for at least 15 seconds o Alternatively, ask patient to squeeze your index and middle fingers and maintain this for 30–60 seconds. Patients with flapping tremor cannot maintain their grip o Also can ask patient protrude tongue OR lift the leg & keep the foot dorsiflexed Ø Look for wasting of intrinsic muscle of hand Arms: Ø Look for purpura / bruising Ø Look for spider nevi Ø Look for petechiae Ø Look for muscle wasting Ø Look for scratch marks Axilla: Ø Check for lymphadenopathy Ø Look for acanthosis nigricans © DR. JOSEPH @ WWW.MSIMASTERCLASS.COM ALL RIGHTS RESERVED SIGN UP IN WWW.FRIENDOCT.COM TO ASSESS TO SOFTCOPY 14 MEDICAL SUCCESS INSIDERS (MSI) FINDINGS Findings Descriptions & Significances Pictures Nails & Fingers Pallor / • Suggests anemia koilonychia • Rarely, exposure to strong detergent Clubbing • Seen in inflammatory bowel disease, coeliac disease / malabsorption syndrome (which cause long-standing nutritional depletion), liver cirrhosis • Up to 1/3 with cirrhosis may have finger clubbing • May be related to arteriovenous (AV) shunting in lungs, resulting in arterial oxygen desaturation • Cyanosis may be associated with severe long-standing chronic liver disease Leuconychia • When chronic liver disease / other (white nails) disease results in hypoalbuminaemia à nail beds opacify (abnormality is of the nail bed and not of the nail), often leaving only a rim of pink nail bed at the top of nail (Terry's nails) • May also occur in à protein calorie malnutrition (kwashiorkor), malabsorption due to protein-losing enteropathy (coeliac disease), or heavy and prolonged proteinuria (nephrotic syndrome) • Thumb & index nails are most often involved • May due to compression of capillary flow by extracellular fluid • Muehrcke's lines (transverse white lines) à can occur in hypo- albuminemia states, including cirrhosis • Blue lunulae à may be seen in Wilson's disease © DR. JOSEPH @ WWW.MSIMASTERCLASS.COM ALL RIGHTS RESERVED SIGN UP IN WWW.FRIENDOCT.COM TO ASSESS TO SOFTCOPY MEDICAL SUCCESS INSIDERS (MSI) 15 Findings Descriptions & Significances Pictures Palms Palmar • Inspect palmar creases for pallor à creases suggesting anaemia which may result from GIT blood loss, malabsorption (folate, vitamin B12), haemolysis (hypersplenism) or chronic disease Palmar • This is reddening of the palms of hands erythema affecting thenar & hypothenar ('liver eminences & pulps of fingers; with palms') centre of palm being spared • Often the soles of feet are also affected • Can be a feature of chronic liver disease • While the finding has been attributed to raised estrogen levels, it has not been shown to be related to plasma estradiol levels, so etiology remains uncertain • Associated with reduced hepatic breakdown of sex steroids • Can also occur with à pregnancy, OCP, thyrotoxicosis, rheumatoid arthritis, polycythaemia & rarely with chronic febrile diseases or chronic leukaemia • May also be a normal finding, especially in women © DR. JOSEPH @ WWW.MSIMASTERCLASS.COM ALL RIGHTS RESERVED SIGN UP IN WWW.FRIENDOCT.COM TO ASSESS TO SOFTCOPY 16 MEDICAL SUCCESS INSIDERS (MSI) Findings Descriptions & Significances Pictures Dupuytren's • Visible and palpable thickening and contracture contraction of palmar fascia/ aponeurosis causing permanent flexion • Most often involves ring finger; later little finger is also affected • It is often bilateral and occasionally affects feet • Associated with alcoholism (not liver disease) • May be familial (autosomal dominant with variable penetrance) • Associated with conditions causing microvascular pathology à diabetes mellitus, smoking, hyperlipidaemia, HIV infection, chronic liver disease • Also found in some heavy manual workers • Palmar fascia of these patients contains abnormally large amounts of xanthine • Can see vertical furrows in the region of 4th & 5th fingers due to thickening Hepatic flap • Should ask patient to stretch out arms [Video available in the / asterixis in front, separate fingers and extend softcopy] the wrists for 15 seconds • Jerky, irregular flexion-extension movement at wrist and metacarpo- phalangeal joints, often accompanied by lateral movements of fingers • It is thought to be due to interference with inflow of joint position sense information to reticular formation in brainstem à results in rhythmical lapses of postural muscle tone • Arms, neck, tongue, jaws and eyelids can also be involved • Patient is asked to close the eyes forcefully / to protrude tongue • The flap is usually bilateral, tends to be absent at
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