2021-06-15 04:16:29
Paediatric Abdominal Examination
General appearance
Inspect the general appearance of the child’s face for signs relevant to the gastrointestinal system:
Oedema: associated with hypoalbuminaemia (e.g. protein-losing enteropathy, malnutrition, liver disease).
Pallor: may suggest underlying anaemia (e.g. malignancy, gastrointestinal bleeding, malnutrition).
Eyes
Inspect the eyes for signs relevant to the gastrointestinal system:
Conjunctival pallor: suggestive of underlying anaemia. Gently pull down their lower eyelid to inspect the conjunctiva.
Scleral jaundice: a yellowish or greenish pigmentation of the eyes due to high bilirubin levels (e.g. liver disease, hypothyroidism, rhesus factor disease).
Aniridia (partial or complete absence of the coloured part of the eye): associated with WAGR syndrome which also involves the development of a Wilm’s tumour.
Kayser-Fleischer rings: dark rings that encircle the iris associated with Wilson’s disease. The disease involves abnormal copper processing by the liver, resulting in accumulation and deposition in various tissues.
Xanthelasma: yellow, raised cholesterol-rich deposits around the eyes associated with hypercholesterolaemia.
Mouth
Inspect the mouth for signs relevant to the gastrointestinal system (tip – ask the child to see how long their tongue is or how big their mouth is):
Angular stomatitis: a common inflammatory condition affecting the corners of the mouth. It has a wide range of causes including iron deficiency.
Glossitis: smooth erythematous enlargement of the tongue associated with iron, B12 and folate deficiency (e.g. malabsorption secondary to inflammatory bowel disease).
Oral candidiasis: a fungal infection commonly associated with immunosuppression. It is characterised by pseudomembranous white slough which can be easily wiped away to reveal underlying erythematous mucosa.
Aphthous ulceration: round or oval ulcers occurring on the mucous membranes inside the mouth. Aphthous ulcers are typically benign (e.g. due to stress or mechanical trauma), however, they can be associated with iron, B12 and folate deficiency as well as Crohn’s disease.
Hyperpigmented macules: pathognomonic for Peutz-Jeghers syndrome, an autosomal dominant genetic disorder that results in the development of polyps in the gastrointestinal tract.
Dental caries: may be associated with neglect or gastroesophageal reflux disease (acid erosion).
Macroglossia: enlargement of the tongue associated with Down’s syndrome, hypothyroidism, mucopolysaccharidoses and Beckwith-Wiedemann syndrome.
Neck
The left supraclavicular lymph node (known as Virchow’s node) receives lymphatic drainage from the abdominal cavity and therefore enlargement of Virchow’s node can be one of the first clinical signs of metastatic intrabdominal malignancy. The right supraclavicular lymph node receives lymphatic drainage from the thorax and therefore lymphadenopathy in this region can be associated with metastatic oesophageal cancer (as well as malignancy from other thoracic viscera).
Palpate for lymphadenopathy
Palpate the supraclavicular fossa on each side, paying particular attention to Virchow’s node on the left for evidence of lymphadenopathy.
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