Abdominal examination

Question 1

look

Answer 1

Distension, scars, symmetry, masses, stoma, drain
Striae, bruising, spider naevi, caput medusae

Question 2

palpation

Answer 2

if there is an area of discomfort- palpation should start away from it

Palpate abdomen with flat hand, flexing slightly at MCPJs
Examine all nine areas of abdomen with superficial palpation
Examine all nine areas of abdomen with deep palpation
Observe patient (face) throughout palpation for reactions that may signal pain or distress

groin hernias

Question 3

how do you assess the liver for organomegaly

Answer 3

• Start in RIF, asking patient to take deep breaths in and out
• Use the edge of index finger to ‘scoop’ upwards on
  inspiration to feel for liver edge
• Move the hand up 2cm with each breath during expiration
• Palpate over any detected hepatomegaly

Question 4

how to you assess the spleen for organomegaly

Answer 4

• Place right hand in RIF
• Use the edge of index finger to ‘scoop’ upwards on
  inspiration to feel for spleen
• Move the hand 2cm each time, working from RIF to LUQ
• If spleen cannot be felt, this can be repeated with patient
  rolled on to their right

Question 5

how do you assess the kidneys for organomegaly

Answer 5

• Place one hand over the back at the level of kidney, the other hand on the anterior abdominal wall, and assess for ballotable kidney

Question 6

percussion

Answer 6

Liver – percuss up from RIF to the right lower costal margin (mid- clavicular line), and percuss down from the fifth intercostal space (mid-clavicular line) to upper border of liver
Spleen – percuss from RIF to LUQ

Question 7

how do you assess for ascites

Answer 7

Inspect for distension
Percuss from midline to flank, listening for dullness
If dullness detected, roll patient towards yourself, wait ten seconds, then re-percuss, to establish if dullness shifts

Question 8

auscultate

Answer 8

Bowel sounds (borborygmi) for up to two minutes before stating that absent
Bruits