ABDO-pt lying flat with head on single pillow: to relax abd muscle

General (5 + 4)
Alert, conscious, well hydrated
Any pain, discomfort
Breathing rate
Obvious scars
Equipment
Distension
Striae
Jaundice
Prominent vein (portal HTN)

Hand (8)
Leuconychia-nail bed opacify,leaving pink line at tip of nail, cause: chronic
liver,hypoalbumin
Koilonychia-spoon nail, cause: IDA,plummer-vinson
Clubbing-IBD,celiac,cirrhosis
Palmar erythema-red thenar,hypothenar,soles of feet, cause: raised estrogen, chronic
liver,DM, thyrotoxicosis,pregnancy,RA,polycythaemia, rarely chronic leukemia.
Pallor of palmar creases-GI blood loss, malabsorbtion B12, folate, chronic dz, hemolysis ie
hypersplenism
Dupuytren’s-thickening, contraction of palmar fascia, results in flexion often ring
finger.cause: alcoholism, manual worker. fascia contains xanthine
AV fistula
Hepatic flap-cause: HE(jerky flexion-extension MCP and wrist, lateral movement of finger),
respi,renal,cardio failure,hypoglycaemia,hypokalaemia,barbiturate. Fine resting tremor-
alcoholic.Apparent tremor-wilson

Arm (5)
Bruising-ecchymosis(large bruising-hepatocellular damage exc factor 8,obs jaundice-factor
2,7,9,10, due to shortage bile acid in small bowel, reduce absorption vit K). Petechiae-
pinhead-size brusing, cause: alcoholism causes bone marrow depression, later causes
thrombocytopenia, splenomegaly 2dary to portal hypertension. DIC in acute hepatic necrosis
Scratch mark-pruritus, cause: obstructive or cholestatis jaundice, commonly PBC
Muscle wasting-malnutrition in alcoholic. Proximal myopathy-alcohol
Spider naevi-central arteriole which radiates into small vessels,arms,neck and chest wall,
pressure causes blanching,release causes refilling, cause:cirrhosis 2dary to alcohol,pregnancy,
rarely viral hepatitis. DDx: Campbell de morgan-do not blanch on pressure,venous stars-2-
3 cm,dorsum of foot,leg,chest wall,increase venous pressure,opposite flow vs spider naevi,
HHT
Axillae-acanthosis nigricans,lymphadenopathy

Mouth,teeth,tongue
Real or false-loose causes ulcer, decayed teeth causes fetor (bad breath)
Fetor-oral hygiene,ketosis,uraemia(fish smell-ammonia),fetor
hepaticus(sweet),alcohol,paraldehyde,cigarette,putrid(anaerobic chest infection-large sputum)
Gum hypertrophy-phenytoin,pregnancy,monocytic leukemia,scurvy,gingivitis due to
smoking,calculus,plaque
Pigmented lesion-metals(lead,bismuth:blue-black,iron:blue-grey,hard palate),drugs:anti-
malaria,OCP:brown or black,Addison:brown or black,peutz-jegher:lips,buccal
mucosa,palate,melanoma:black,painless
Lingua nigra-keratin,bismuth
Geographical tongue-painless,discoloured,slowly changing red rings and lines on the
surface of tongue, B12 def
Leucoplakia-white thickening of mucosa,also on anus,larynx,vulva,premalignant,cause:5s
sore teeth aka poor hygiene,sepsis,smoking,spirit,syphilis
Glossitis-smooth tongue,cause:iron,folate,B12 def,alcoholic,rarely carcinoid
Angular stomatitis-cracks at corner,cause: B6,B12,folate,iron deficiency
Macroglossia-enlarged tongue,cause:Down,acromegaly,tumour,amyloidosis
Ulceration-Aphtous(crohn and celiac),drugs ie sterois,gold,trauma,
uncommon:crohn,UC,celiac,behcet,reiter,erythema multiforme,herpes,syphilis
Moniliasis

Face, neck,chest
Pallor conjunctiva, yellow sclera, iritis due to IBD
Kayser-Fleischer-brownish green ring at the periphery of cornea,copper deposit in descemet
membrane of cornea,wilson’s and cholestatic liver dz
Xanthelasma-yellow plaque in sc tissue in periorbital area,lipid deposit,cause: cholesterol
and PBC.
Periorbital purpura aka black-eye syndrome-after proctosigmoidoscopy,
cause:amyloidosis
Parotid swelling-bilateral(mumps can be unilateral,sarcoidosis,lymphoma,mikulicz(early
sjogren),alcohol,malnutrition,dehydration due to renal failure,carcinomatosis,severe
infection), unilateral(mixed tumour occasionally bilateral, tumour infiltrate + facial palsy,
calculus-palpate opposite upper second molar)
Submandibular swelling-chronic liver dz
Gynaecomastia-chronic liver dz,alcoholic cirrhosis,chronic hepatitis,spironolactone,
cimetidine,digoxin,alcoholic w/o liver dz

Abdomen (4)
Local swelling- reducible or not
Pulsation
Tattoo
Scars

Palpation & percussion (6)

8 quad- light and deep
Liver (percuss too)
Spleen (percuss too & throt sign)
Kidney (ballot)
Shifting dullness (more sensitive)
Fluid thrill
Auscultate (1)
Bowel sound (periumbilical)