Abdominal exam

Question 1

Introduction?

Answer 1

1 - Introduce yourself
2 - Confirm patient's details
3 - Explain the procedure
4 - Gain consent
5 - Ask if they have any pain before starting

Question 2

Pre-procedure

Answer 2

Wash hands

Question 3

First step?

Answer 3

General Inspection

body habitus, abdominal distension, visible masses

Question 4

Second step?

Answer 4

HANDS
1 - Look at them
2 - Finger clubbing (Schamroth's Window test)
3 - Capillary refill time
4 - Assess for asterixis

Question 5

Third Step?

Answer 5

Move to the EYES and FACE
1 - Any lesions?
2 - Conjunctival pallor
3 - Jaundice?
4 - Inspect mouth and tongue
5 - Palpate the lymph nodes (position yourself BEHIND the patient)

Question 6

Fourth step?

Answer 6

Inspect the chest

telangiectasis or spider naevis?

Question 7

Fifth step?

Answer 7

Abdominal exam per se

1 -Position patient in the flat position
2 - Inspection
3 - Auscultation of four quadrants (including renal and aortic bruits)
4 - Light, then deep palpation
5 - Palpate the liver
6 - Palpate the spleen
7 -  Ballot the kidneys
8 - Palpate the aorta
9 - Percussion of the liver and spleen

Question 8

***What are the 9 quadrants of the abdomen?

Answer 8

Right/left hypocondrium
Right/left flank
Right/left iliac fossa
epigastrium, umbilical region, suprapubic region

Question 9

If you suspect ascites, you can do…

Answer 9

Shifting dullness test
(where the percussion is dull, put the finger and ask the patient to roll on their side, then wait 30 seconds and percuss again.
Ascites is suspected if the sound changes)

Question 10

Last step?

Answer 10

Thank the patient
Wash hands again
Summarise the history:

“Today I’ve performed a abdominal exam on James, a 20 year old male. He had no peripheral stigmata of gastrointestinal disease. His abdomen was soft and non-tender, with no masses or organomegaly. On auscultation, he had normal bowel sounds. This was a normal abdominal exam.”