ICM

• Examination: Inspection, Palpation, Percussion, Oscultation
• Spider naevi = liver disease
• clubbed nails = liver disease
• Palpate spleen starting from right iliac fossa, diagonally ascending
• Palpate liver from right iliac fossa, vertically ascending
• central air pocket surrounded by fluid - partial distension - can be percussed - moves to side when patient is rotated from supine
• jaundice = yellowed eyes + skin --> look down, eyelid up
• anaemia = ridged nails, pale conjunctivae --> look up, skin down
• submental, submandibular, preauricular, tonsilar, anterior cervical, posterior cervical and supraclavicular

  
• palpable lymph node = infection = ~pea sized --> supraclavicular = stomach cancer
• palpate inguinal region for potential hernias - get patient to cough while holding down to feel for lump
• get patient to breathe in while palpating liver/spleen --> usually hidden under ribcage
• vomition involves the contraction of the diaphragm and anterior abdominal wall to increase pressure in abdominal cavity
• green vomit = bile from small intestine past duodenum
• examine abdomen with patient flat but one pillow, other times at 45 degrees
• look for muscle mass, level of mentation, attachments, mobility aids, lines, stomas
• start at hands, then head, then down to toes
• Dupuytren contracture is an abnormal thickening of the skin in the palm of the hand, can cause involuntary curling over time
• leukonychia = white spots on nails, indicative of stress during formation
• palmar erythema = pregnancy/liver cirrhosis
• palmar pallor = aneamia
• asterixis = in liver failure, patient can't hold hands like to push something without involuntary shaking. keep up for 15 seconds. indicative of hepatic encephalopathy --> ammonia impedes brain function
• angular stomatitis = cracked corners of mouth = indicative of anaemia
• inspect mouth for ulcers, rotting teeth, can look at tonsils if necessary
• pressure applied to the central arteriole in a spider naevi will cause blanching followed by refilling from the centre first
• Gynaecomastia = chronic liver disease. Thumb and fore finger to pinch --> test for muscle vs fat (fat is softer)
• Arms should be at sides for abdo axam
• when viewing abdomen, look for scars, distension and masses
• caput medusae = like a massive spider naevi around the umbilicus
• oscultate renal arteries to rule out renal artery stenosis. normal veins have laminar flow. blockages will cause a whooshing sound. at level of L1 vertbrae
• auscultate for bowel sounds. decreased distally = obstruction, increased proximally