What signs will you find in a patient with Chronic Liver disease? Difference between Ascites and Abdominal mass? State the general procedure used for examining the abdomen? How do you differentiate between hernia and hydrocele? Where can you find d the apex heart beat? What signs can you find on the hands? Signs you will notice in general examination?
1. Jaundice/scleral icterus, raised JVP, flapping tremor, ascites (shifting dullness), spider nevi (reduced oestrogen metabolism), signs of portal HT (caput medusae, haemorrhoids) splenomegaly/hepatomegaly, nail changes including leukonychia 2. Ascites = fluid accumulation, mass = mass (an intraperitoneal mass or infection may lead to the development of ascites) 3. General inspection, Gently palpate 9 regions, deeper palpating of 9 regions, feel for liver and percuss size, feel for spleen, percuss for shifting dullness, assess spleen while lying on side, ballot kidneys, auscultate for bowel sounds, aortic/renal bruit 4. Hydrocele: transilluminates, generally not worsened with raised intra abdominal pressure. Hernia: palpable origin from deep inguinal ring and sometimes reducible, generally no transillumination. May produce bowel sounds. 5. 5th intercostal space, mid clavicular line 6. Hepatic flap, leukonychia, palmar erythema, Dupytren’s contracture (associated with alcoholism) 7. See number 1. Signs of hepatic encephalopathy if severe.
