Beruflich Dokumente
Kultur Dokumente
Inspection
Look around the bed Oxygen mask/nasal prongs, drips, cigarettes,
special foods, diabetic diet
Look at the patient Comfortable at rest, wound drain, catheter, NG
tube, jaundice, scratch marks, spider naevi,
gynaecomastia, striae, bruising, anaemia,
pigmentation, cachexia, dehydration, abdominal
distension, abdominal masses, scars (rooftop, L-
shape, Mercedes-Benz, subcostal, midline, Lanz,
Hockeystick, inguinal), Sister Mary Joseph
Nodule, Grey-Turner’s/Cullen’s sign, stomas,
acanthosis nigricans, tattoos
Look at the hands Clubbing (cirrhosis, lymphoma, IBD, Coeliac
disease), leukonychia (hypoalbuminaemia),
koilonychias (iron deficiency), palmar erythema,
Dupuytren’s contracture, anaemia, tendon
xanthomata, liver flap
Look at the eyes Jaundice, anaemia, Kayser-Fleischer rings,
xanthelasma
Look in the mouth Ulcers, pigmentation, telangiectasia, fetor
hepaticus, Candida, angular stomatitis, gums,
smooth tongue, leukoplakia, atrophic glossitis,
macroglossia
Palpation
→ Inspect the abdomen again, including asking the patient to raise their head or legs
Auscultation
Final manoeuvres
Examine the ankles for oedema
Examine the hernial orifices (or say you
would, as below)
Glossary
Spider naevi – telangiectasia with a central arteriole from which radiate numerous small vessels. Found in the
distribution of the SVC, and due to hyperoestrogenic state in liver failure.
Leukonychia – whitening of the nails due to hypoalbuminaemia
Koilonychia – “spoon-shaped” nails due to iron deficiency
Dupuytren’s contracture – thickening of the palmar fascia, seen in relation to excess alcohol intake, DM,
epilepsy and hereditary.
Sister Mary-Joseph nodule – umbilical nodule due to metastatic cancer
Grey-Turner’s/Cullen’s signs – flank/periumbilical bruising seen in pancreatitis
Kayser-Fleischer rings – green-brown rings seen in the iris in Wilson’s disease
Fetor hepaticus – a musty-sweet smell found in liver failure
Angular stomatitis – cracks seen at the corner of the mouth, seen in iron deficiency
Leukoplakia – white tongue: smoke, spirits, sepsis, syphilis, sore teeth
Atrophic glossitis – a smooth tongue, seen in vit B12 and folate deficiency (amongst other things)
Acanthosis nigricans – velvety pigmented plaques in the axilla and back of the neck, seen in GI malignancy
(and several other conditions)