Abdominal examination:
General Examination
- General surroundings
- equipments : NG tube/ PEG tube
- nutrition: milk, food
- Growth chart
- Hand
- finger clubbing
- crt, pulse volume, warm/cold peripheries
- rashes?
- Face
- eyes: anemia? edema?
- mouth: gum bleed/ hydration
- cyanosis
- overall inspection
- Neck
- spider naevi
- inflammation/ edema on the neck
- lymph node
- Abdomen
- Inspection
- shape
- distension
- masses
- rashes/scar/striae/stoma
- Palpation
- pt should be in supine position, gently ask if it is comfortable to lie down if having abdominal distension
- superficial, deep palpation
- liver/ spleen/ kidney palpation/ abdominal mass
- Percussion
- shifting dullness/ fluid thrill
- Auscultation
- resonance/ dull
- Lower back
- sacral edema?
- Lower limbs
- pedal edema
- Nephrotic syndrome : ascites/ periorbital edema/ pedal edema/ sacral adema/ pleural effusion
Causes of hepatomegaly
1. Structural: Extrahepatic biliary atresia, choledochal cyst, intrahepatic biliary hypoplasia, congenital hepatic fibrosis, polycystic disease
2 . Storage/ metabolic:
– Carbohydrate- glycogen storage disease (Type 1,3,4,6), hereditary fructose intolerance, galactosaemia,, mucopolysaccaridoses-
– Mineral: Wilson’s disease, juvenile haemachromatoses
-Nutrition: Protein calorie malnutrition, TPN-Bile flow: progressive familial intrahepatic cholestaisis syndrome
-Protease: Alpha-1-antitripsin
-Electrolyte: CF
– Amino acid: Tyrosinaemia type 1, urea cycle disorder
-Lipid – Gaucher, Nieman-Pick diease, cholesteryl ester storage disease
3. Haematological: Thalassaemia, sickle cell disease, ALL, AML CML
4. Heart/ Vascular: Congestive heart failure, constrictive pericarditis, obstructive IVC, Budd-Chiari syndrome
5. Infection: Viral – rubella, CMV, coxsackie virus, echovirus, hepatitis ABCDE, EBV ; Bacteria – E.coli TI, TB, syphilis ; Parasite – Malaria, toxoplasmosis, Schistosomiasis
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