2. Clinical examination of the Abdomen / GU

Question 1

GU/abdomen examination

Answer 1

Intro
General inspection
Close inspection of the hands
Radial pulse
BP/temp (on charts)

Chest/axillae/ abdomen:
Close inspection of face
Close inspection chest/axillae
Palpation of chest/axillae
Palpate bladder
Palpate of kidneys 
Feel abdominal aorta
Percussion liver, spleen and bladder
Percussion for ascites 
Auscultation of the diaphragm

Back:
Inspect
Palpate for renal tenderness and cervical lymph nodes

Other areas:
• Offers to examine groin
• Offers to examine genitalia
• Requests to do digital rectal examination (DRE)

Question 2

Conditions to look for during close inspection of the face in GU/abdomen of the face

Answer 2

Jaundice
Mouth:
- Glossitis
- Oral candidiasis
- Angular stomatisis
- Peutz-jegers syndrome
- Telangiectasia

Question 3

How to examine chest/ axillae during GU/abdomen exam?

Answer 3

Inspect chest for spider naevi, gynaecomastia in men, and both axillae for loss of axillary body hair.
Movement, distension, scars, hernia, masses etx.

Palpation:
-Superficial to deep
- Ask patient to point to painful area
-Palpate all 9 regions
- Watch patients face
Liver:
-Begin in right iliac fossa
-Ask patients to breath in and o§ut deeply
-Palpate upwards to right costal margin
- Feel for liver edge descending on inspiration. Shouldn't feel anything

Question 4

What is Murphy’s Sign?

Answer 4

• Feel for gall bladder tenderness (e.g. acute cholecystitis)
• Patient breathes in whilst you gently palpate RUQ in mid-
clavicular line
• On liver descent contact with inflamed gallbladder causestenderness and sudden arrest of inspiration

Question 5

What is Courvoisier’s Sign?

Answer 5

• Painless jaundice and a palpable gallbladder

* Likely due to extrahepatic obstructionmE.g. Pancreatic cancer, UNLIKELY to be gallstones

Question 6

What is the process to check for splenomegaly?

Answer 6

1. Ask the patient to breathe in and out deeply
2. Palpate upwards to left hypochondrium
3. Feel for edge of an
   enlarged spleen as it descends on inspiration

Characteristic notch may be palpable
Move hand between each breath

Question 7

Percussion of liver, spleen and bladder method

Answer 7

Percuss up to right costal margin for lower border of liver
Percuss downwards from just above right nipple for upper border of liver
Percuss towards left hypochondrium for lower border of spleen
Percuss from umbilicus down in midline for bladder

Question 8

What is ascites?
Causes?
Method?

Answer 8

 Abnormal collection of fluid in peritoneal cavity

 Causes:
– Hepatic cirrhosis
– Intra-abdominal malignancy – Nephrotic syndrome
– Cardiac failure
– Pancreatitis
– Constrictive pericarditis etc.

Method:
 Start in mid-line
 Percuss towards flanks
 Shifting dullness and Fluid thrill

Question 9

How is the diaphragm auscultated?

Answer 9

 Listen for normal bowel sounds (up to 2 min)
 Auscultate for abdominal aortic bruits
 Auscultate renal arteries

Question 10

Why are the cervical lymph nodes examined?

Answer 10

 May indicate local disease
 May indicate more distant disease:
– Tumours of the upper gastrointestinal tract may metastasise to the lower part of the left posterior cervical triangle
– Virchow’s node / Troisier’s sign

Question 11

Rectal examination:
Indications?
Key points?

Answer 11

 Indications:
– Rectal bleeding
– Prostatic symptoms
– Change in bowel habit
– Possible spinal cord injury

Key points:
- Explain procedure
- Gain informed consent
- Offer a chaperone

Question 12

How is the female reproductive system examined?
Indications?
Pathology?

Answer 12

 Pelvic examination
– Bi-manual = one hand palpates per vagina and other per abdomen

Indications:
 pelvic pain
 abnormal vaginal bleeding
 abnormal vaginal discharge
 if considering vaginal or uterine prolapse

Female pelvic pathology:
- Ovarian pathology E.g. Ovarian cyst, malignancy
- Uterine pathology E.g. Uterine prolapse, fibroids, cervical carcinoma,
carcinoma of body of uterus
- Vaginal pathology E.g. vaginitis , prolapse
- Pelvic infection (Pelvic inflammatory disease)
- Ectopic pregnancy - do a pregnancy test
- Always consider a pelvic ultrasound scan

Question 13

How is the male reproductive system examined?

Pathology?

Answer 13

Testicular exam
Pathology:
– Infection (epididymitis, orchitis, epididmyo- orchitis)
– Testicular torsion
– Epididymal cysts
– Testicular tumours
– Indirect inguinal hernia