Abdominal exam

Question 1

Introduction

Answer 1

Clean hands
Introduction
Check name and DOB/age
Explanation and gain consent

Question 2

End of Bed?

Answer 2

Immediate intervention required?
In pain?
Vomit bowls/ IV fluids /NEWS chart/ medication

Question 3

Hands and arms

Answer 3

Tar staining
Nail colour - anaemia, leukonychia (hypoalbuminaemia)
Nail shape - pitting, koilonychia (iron deficiency anaemia), clubbing (cirrhosis, IBD, coeliac)
Palms - palmar crease pigmentation, Dupuytrens contracture
Arms - bruising, scratch marks, muscle wasting, track marks, skin turgor
Flapping tremor - liver flap
Fine tremor - alcohol withdrawal
Pulse, resp rate, BP

Question 4

Head and neck

Answer 4

Face - parotid swelling (alcohol)
Mouth - angular stomatitis, sore red tongue (anaemia), foetor hepaticus (mouldy hay) in liver failure
Eyes - jaundice, anaemia
Lymph nodes - Virchow’s node on left

Question 5

Chest

Answer 5

Spider naevi

Gynaecomastia and loss of body hair in males

Question 6

Legs

Answer 6

Peripheral oedema
Loss of body hair
Erythema nodosum (eg IBD)

Question 7

Abdomen inspection

Answer 7

Scars (surgery or trauma)
Visible pulsation (?abdominal aorta)
Movement with respiration (shallow/absent with severe abdo. pain)
Skin lesions (e.g. secondaries)
Scratch marks (chronic cholestasis/ liver failure)
Abdominal shape - scaphoid/obese
Stoma (ileostomy/colostomy)
Distended veins “caput medusae” - portal hypertension
Petechiae (liver dysfunction)
Striae (weight loss)
Abdominal distension - 5Fs (fat, faeces, flatus, fluid or foetus)

Question 8

Abdomen palpation

Answer 8

Light - 9 regions, tenderness, guarding, watch patient face
Deep - 9 regions, masses
“soft, non tender, no palpable masses”
Palpate for liver edge, spleen edge
Palpate kidneys (deep bimanual palpation)

Question 9

Abdomen percussion

Answer 9

Percuss up to liver edge
Percuss up to spleen edge
Free fluid - shifting dullness and fluid thrill

Question 10

Abdomen auscultation

Answer 10

Bowel sounds (only not present after 2 minutes)
Bruits - aortic, renal, hepatic, splenic
Hepatic and splenic rub

Question 11

Full abdominal examination

Answer 11

To complete a full abdominal examination I would examine the hernial orifices, perform a digital rectal examination and examine external genitalia if indicated.

Question 12

Closure

Answer 12

Help them dress
Clean hands
Document findings