The abdominal station in MRCP PACES should be a ‘set piece’ that can be approached with confidence. You are likely to encounter patients with chronic stable disease such as chronic liver disease, haematological malignancy with associated hepatosplenomegaly and chronic kidney disease, particularly those undergoing some form of renal replacement therapy, for instance dialysis or transplantation. Signs in the abdomen are generally straightforward to elicit and the commonest obstacles to passing are poor presentation or a failure to put the features together in a logical fashion. Many diagnostic findings in the abdominal station can be identified by inspection alone, so particular attention should be paid to adequate exposure and the identification of extra-abdominal signs (e.g. multiple spider naevi of chronic liver disease, telangiectasia of hereditary haemorrhagic telangiectasia and xanthelasmata in primary biliary cirrhosis). Do not forget to have a good look at the back as important signs may be restricted there (e.g. spider naevi or posterior nephrectomy scars). During the observation phase, attention should be paid to the nutritional status of the patient and to any other available clues (for instance, one of the authors, BA, diagnosed bilateral adrenalectomies from a medic alert bracelet at the bedside in his MRCP exam). The presence of abdominal scars is very useful as they usually overlie the organs that have been surgically handled. Whist surgery is frequently concerned with resecting parts or the whole of organs, remember that organs, including kidneys, pancreas and liver, may also be transplanted. As a result of a detailed end-of-the bed examination, sufficient information may be garnered to allow a diagnosis to be formulated, with subsequent palpation, percussion and auscultation, simply confirming the suspected diagnosis. Keep to a well-practised order to produce a fluid display which you should be able to complete in around 5 minutes. 1. Introduce yourself to the patient and lie them down if this has not already been done. Ask if there is pain or tenderness anywhere. 2. Inspect the patient from the end of the bed. Ensure that you look for any additional clues, such as those around the bedside.
Prospective study of periostitis and finger clubbing in primary biliary cirrhosis and other forms of chronic liver disease.
