Advanced Health Assessment: Abdominal and Systems Examination

Vocabulary practice flashcards covering abdominal assessment, clinical signs, pathophysiology, auscultation parameters, special examination tests, and nine anatomical abdominal regions.

Intro

My name, consent, infection prevention and control, maintain privacy and dignity, communication.

Initial check

Comfortable without signs of distress

Able to lie flat

Able to cough without abdo pain

Abdo wounds, drains, intact skin

Vital signs

Focused history

Abdo pain - SOCRATES

Nausea and vomiting

Bowel habits - any change, constipation, diarrhoea, melana, frank blood, mucous

Weight change, indigestion, loss of appetite

Dysphagia

Dysuria, urgency, frequency, hesitancy

Urinary incontinence, polyuria, nocturia

Heamaturia

Female - obstetric history / LMP / discharge

Previous abdo illness, injury, surgery

Medication history

Allergies

Family history

Occupational hx

Social gx

Hands

Colour

Normal - pink and perfused

Abnormal - pallor,

Differentials - anaemia, hypoperfusion

Warmth

Normal - warm

Abnormal - cool, cold, hot

Differentials - hypoperfusion

Fluid status

Normal - no oedema

Abnormal - liver heart failure

Fingernail shape

Normal - normal shape

Abnormal

Clubbing - which could be liver failure, inflammatory bowel disease, malabsorption

Kolionychias (spooning) - iron deficiency, anaemia

Leukonychia (white discolouration) - hypoalbuminemia

Palmar Erythema

Abnormal redness of the palms associated with liver failure, pregnancy, rheumatoid arthritis, or an increase in oestrogen.

Dupuytren's Contracture

Fibrotic contracture affecting the palms, identified as a clinical sign of liver cirrhosis.

Asterixis

A flapping tremor of the hands indicative of liver failure, hepatic encephalopathy, or $CO_2$ retention in the cardiovascular and respiratory systems.

Arms

Normal

Colour and axillea hair

Abnormal - loss of hair

Acanthosis Nigricans

Darker areas of skin that may indicate non-alcoholic fatty liver disease, cancer, Cushing's syndrome, or insulin resistance.

Eyes

Spider Naevi

Vascular lesions found on the face, upper thorax, or abdomen associated with chronic alcohol abuse, chronic liver disease, liver cirrhosis, or portal hypertension.

Angular Stomatitis

Inflammation or lesions at the edges of the lips caused by iron deficiency, vitamin $B_{12}$ deficiency, or folate deficiency.

Caput Medusae

Dilated, snake-like collateral venous circulation visible on the abdominal wall, indicative of portal hypertension, chronic liver disease, liver cirrhosis, or obstruction to the inferior vena cava.

Grey-Turner's Sign

Bruising or petechiae over the retroperitoneal area and flanks; a late sign indicating abdominal bleeding, clotting disorder, haemorrhagic pancreatitis, or an abdominal aortic aneurysm (AAA).

Normal Bowel Sounds

Auscultated clicks and gurgles present in all $4$ quadrants at a rate of $5\text{--}35/\text{minute}$.

Absent Bowel Sounds

The complete absence of auscultated bowel sounds for more than $5\text{ minutes}$, indicating paralytic ileus, a mass or tumour, or late obstruction.

Hyperactive Bowel Sounds

Increased bowel motility marked by $>35$ clicks or gurgles in a minute or high-pitched tinkling sounds, indicating early small bowel obstruction or gastroenteritis.

Hypoactive Bowel Sounds

Infrequent bowel sounds occurring at $<5$ clicks or gurgles in a minute, caused by late small bowel obstruction, faeces-filled colon, post bowel surgery, or opiates.

Borborygmi

Very loud, prolonged growling or rumbling bowel sounds heard on auscultation.

Abdominal Bruit

A vascular murmur heard with the bell of the stethoscope over aortic and renal regions, indicating aortic narrowing, dissection, or obstruction.

Splenic Friction Rub

A friction rub auscultated over the lower left rib cage in the left anterior axillary line, arising from a splenic abscess, infection, or tumour.

Hepatic Friction Rub

A friction rub heard over the lower right rib cage under the costal margin, caused by a liver abscess or metastatic tumour.

Rebound Tenderness

A clinical test positive when release of deep pressure causes increased pain (evaluated in $>1$ area), indicating peritonitis, acute abdomen, perforated colon, or sepsis.

Murphy's Sign

A test for cholecystitis that is positive when the patient experiences pain while breathing in during palpation under the right costal margin.

Appendicitis Special Tests

Physical examination manoeuvres including McBurney's point tenderness, the psoas sign, and the obturator sign (with only one demonstrated during an OSCE).

Shifting Dullness Test

A percussion test where the transition line between tympany and dullness shifts with patient repositioning, confirming ascites from portal hypertension or chronic liver failure.

Fluid Wave Test

A physical assessment technique used to detect ascites from portal hypertension or chronic liver failure by transmitting an impulse wave through abdominal fluid.

Right Hypochondrial Region

The upper right abdominal quadrant containing the liver, gallbladder, right kidney, and small intestine.

Epigastric Region

The upper central abdominal region containing the stomach, liver, pancreas, duodenum, spleen, and adrenal glands.

Left Hypochondrial Region

The upper left abdominal region containing the spleen, colon, left kidney, and pancreas.

Right Lumbar Region

The middle right abdominal region containing the gallbladder, liver, and right colon.

Umbilical Region

The central abdominal region surrounding the umbilicus, containing parts of the small intestine and duodenum.

Left Lumbar Region

The middle left abdominal region containing the descending colon and left kidney.

Right Iliac Region

The lower right abdominal region containing the appendix and cecum.

Hypogastric Region

The lower central abdominal region containing the urinary bladder, sigmoid colon, and female reproductive organs.

Left Iliac Region

The lower left abdominal region containing the descending colon and sigmoid colon.

Abdominal Dullness

An abnormal percussion sound over the abdomen that deviates from general tympany, indicating a mass, stool, fluid, flatus, or a foetus.