Examination Of The Abdomen

Examination of the abdomen
Inspection
Face – pallor, pigmentation, jaundice, xanthelasma, bilateral parotid enlargement, spider naevi
Eye –pallor, jaundice, xanthelasma, Kayser-Fleischner’s ring (more with slit lamp)
Lip – cyanosis
Mouth –mouth ulcers (Crohn’s), candidiasis (HIV), telangiectasia (Osler-Weber-Randu ), patches of pigmentation (Peutz-Jeghers)
Neck –cervical lymphadenopathy (lymphoma, CLL), JVP (cardiac cirrhosis), spider naevi
Extremities
Upper limb –arteriovenous fistula for haemodialysis
Twenty signs that may be present in patients with chronic liver disease
Clubbing
Dupuytren’s contracture
Palmar erythema
Spider naevi
Flapping tremor
Leuconychia
Koilonychias
Paronychia
Scratch marks
Icterus (jaundice)
Pallor
Pigmentation
Purpura
Cyanosis
Xanthomata
Abscesses
Oedema
Muscle wasting
Tattoo
Needle marks (IVDU)
Lower limb – muscle wasting, peripheral neuropathy (motor), oedema, bruises
Chest – gynaecomastia, spider naevi, paucity of hair (axilla, facial hair in male, pubic hair)
Abdomen –abnormal pulsations, generalized distension (ascites), swelling in one particular area, any scar, umbilical hernia, inguinal hernia, femoral hernia, fistulae, distended abdominal veins (the flow is away from the umbilicus in portal hypertension but upwards from the groin in inferior vena cava obstruction)

Palpation
Parotid enlargement
Gynaecomastia
Hepatomegaly
Splenomegaly
Hepatosplenomegaly
Kidney enlargement (ballotable)
Shifting dullness and fluid thrill for ascites
Percussion
Upper border of liver – 5th intercostal space in right midclavicular line, 7th intercostal space in right midaxillary line, 9th intercostal space in subscapular line
Upper border of spleen – 6th -7th ribs anteriorly
Difference between spleen and kidney enlargement

Spleen kidney Upper border
Not palpable
Palpable (you can get about it)
Medial notch
Yes
No
Movement with respiration
Downwards and medially
Downwards only
Ballotable
No
Yes
Percussion
Dull over spleen
Resonant