Abdominal Examination

Question 1

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Answer 1

Intro
“Today I am going to examine your abdomen. This will involve looking from the end of the bed, feeling various areas of the abdomen and then listening at the end. Will that be okay?”
Ask if they have any pain
Bed at 45 degree angle
Expose the patient

Question 2

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Answer 2

General Inspection
Check for clinical signs - body habitual, masses, confusion, pain, noticeable scars, abdominal distension, pallor, jaundice, hyperpigmentation, oedema, cachexia, hernias…
Look for objects or equipment - stoma bag(s), surgical drains, feeding tubes, medications, catheters

Question 3

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Answer 3

Hands
“I’d like to start by looking at your hands, can you bring them up in front of you please”
Inspect:
Palms for pallor, palmer erythema and dupuytren’s contracture
Nail signs including koilonychia and leukonychia
Assess for finger clubbing
Palpate for Dupuytren’s contracture
Assess Temperature
Assess for asterixis
Inspect axillae
Inspect forearms

Question 4

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Answer 4

Check the patient’s pulse and blood pressure

Question 5

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Answer 5

Inspect the face and the eyes
Pull down on the lower eye lid

Question 6

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Answer 6

Inspect the Mouth
“Can you open your mouth for me please…
Lift your tongue to the roof of your mouth “

Question 7

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Answer 7

Palpate the lymph nodes in the neck and supracalvicular fossae

Question 8

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Answer 8

Inspect the chest

Question 9

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Answer 9

Ask the patient to sit forward so that you can inspect the skin of their posterior abdominal wall
At this point lower the bed to flat
Ask the patient to lie flat with one pillow, if tolerated, arms by their sides

Question 10

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Answer 10

Inspect the abdomen

Question 11

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Answer 11

Palpate the nine regions of the abdominal wall gently and symmetrically, whilst observing the patient’s face
Repeat with deeper palpitations

Question 12

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Answer 12

Palpate the liver

Question 13

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Answer 13

Palpate the spleen

Question 14

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Answer 14

Ballot the kidneys

Question 15

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Answer 15

Palpate the bladder

Question 16

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Answer 16

Palpate the aorta

Question 17

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Answer 17

Check for Murphy’s sign

Question 18

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Answer 18

Percuss the abdomen
- liver: Percuss from resonant to dull
-spleen: Castell’s method
-the bladder
-if ascites is suspected, test for shifting dullness

Question 19

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Answer 19

Auscultation of the abdomen
-Are bowel sounds present and normal
- Listen for aortic and femoral bruits

Question 20

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Answer 20

Conclusion
In summary, I performed an abdominal exam on…, they had no peripheral stigmata of gastrointestinal disease, their abdomen was soft and non tender, with no masses or organomegally, on auscultation he had normal bowel sounds. This was a normal abdominal exam.

To complete exam, I would like to examine the inguinal lymph nodes, the stools if clinically indicated, the hernial orifices, do a rectal examination, obtain urinalysis, and examine the genitalia