Peripheral stigmata for abdominal disease

While performing the General Examination for a patient with abdominal complain you should emphasis in searching for these signs.

Peripheral stigmata for abdominal disease

Hand

  1. Clubbing
  2. Koilonychias ‘spoon-shaped nail’ (iron-deficiency anemia)
  3. Leukonychia ‘white nails’ (liver disease – fungal infection)
  4. Liver flap (uncompensated liver disease)
  5. Palmer erthema (liver disease)

Eyes

  1. Pallor (anemia)
  2. Jaundice

Mouth

  1. Hepatic foetor
  2. Pallor (anemia)
  3. Ulcer
  4. Pigmentation (peutz-jeghars)

Neck

Supraclavicular L.N.s

Upper trunk

  1. Gynecomastia
  2. Spider naevi
  3. Scratch marks
  4. Pulse

Lower limb

Edema

Abdominal Examination

 

Abdominal examination

Inspection

General

Contour

Movement with respiration

Visible peristalsis

Skin (Scar – Striae – Scratch marks – Veins – Haemorrhage)

Specific

Breast
Subcostal angle
Epigastric pulsation
Divercation of recti (هم براسك او كح)

Umbilicus

Site

Shape (Inverted – Everted)

Skin (Pigmentation – Nodules – Discharge – Ulcer – Scar)

Impulse on cough (هم براسك او كح)

Suprapubic hair distribution
Hernia orifices (هم براسك او كح)
External genetalia

Palpation

Superficial Tenderness – Rigidity – Superficial swelling
Deep Tenderness – Swelling

Organs

Liver

1st do tidal percussion

Size

Border

Surface

Consistency

Tenderness

Pulsation ‘bimanually’

Spleen Size

Border

Surface

Consistency

Tenderness

Notch

Pitting

Kidney Size

Right and left

Surface

Consistency

Tenderness

Bladder Size

Consistency

Tenderness

Colon
Lymph nodes
Aorta
Gall bladder

Percussion

  • Liver (and Tidal percussion)
  • Spleen (and Truab’s area)
  • For ascites (Transmitted fluid thrill – Shifting dullness – Knee elbow position – Ultrasound)
  • Bladder – Any mass

Auscultation

  • Intestinal sounds – Arterial bruit (Renal – Superior mesenteric – Iliac – Femoral)
  • Venous hum
  • Rub (Perisplinitis – Perihepatitis)
  • Succession splash
  • Scratch test
Never forget to examine

History taking, Symptoms and DDx of abdomen and GIT 

  • Abdominal pain
  • Abdominal swelling
  • Related to esophagus and mouth
    • Halitosis – Salivation – Dysphagia – Heart burn – Reflux – Painful swallowing or odynophagia
  • Related to upper GIT
    • Dyspepsia or indigestion – Eructation – Flatulence – Hiccups – Vomiting – Retching
  • Related to lower GIT
    • Bowel habits – Constipation – Diarrhea – Dysentery – Worms in stool
  • Related to bleeding
    • Haematemesis – Rectal bleeding – Melena
  • Hepatobiliary
    • Jaundice – Itching – Encephalopathy – Bleeding tendency – Weight loss
  • Constitutional manifestations
    • Fever – Headache – Malaise – Sweating – Fatigue

Clinical presentation of some abdominal/GIT disorders of surgical importance