Abdominal Examination and History

Question 1

Name how to take a abdominal history

Answer 1

History of presenting compliant
- What have you come to see us with today?
- Do you have any other symptoms?
- How are you feeling at the moment
- How long has it gone on for
- Has this happened before and when did it start
- What does it (pain) feel like
- Do it start suddenly or a gradual onset
- Where speficially is the pain and does it spread
- What is the character of the pain
– does anything make it better or worse
- can you rate the pain on a scale of 0-10
- How are you generally – are you fit and well

Then go into more specific questions about symptoms:

• were you the only one to eat this
• what does the vomit look like
• any blood in the vomit
• any difficulty swallowing
• any difficulty breathing
• any changes in urination
• any changes in poo - do you have diarrhoea

Ideas Concerns Expectations

• Do you have any idea of what might be going on
• Is there anything that is worrying you specifically
• What were you hoping id be able to do for you today

Past Medical history 
- Do you have any medical conditions 
- Have you seen anyone for this before 
Specific questions 
-	Have you had contact with those that are unwell recently 
-

Drug history and allergies

• What prescribed medication do you take
• What over the counter medication do you take
• Have you taken any illicit substances?
• Do you have any allergies?

Social history

• What do you do for a living
• Do you smoke – how long have you smoked, how many cigarettes do you smoke a day
• Do you drink
• Where do you currently live
• Do you have a support network that helps you
• Do you require any assistane in day to day life
• How much exercise do you do – how often and what type

Family History
- Has your family had any significant illness
- Are they well and still alive
Systematic review
Now just before we finish I just have some quick general questions to ask
- Have you had a fever
- Any weight changes
- Do you fill fatigued
- Have you had a cough?
- Do you get any stomach pain or nausea and vomiting
- Are you going to the toilet as usually?
- Have you had a headache, any visual changes, or motor and sensory disturbances
- Any chest wall pain, or trauma
- Do you have any rashes or other skin problems

Before I examine you is there anything else that you would like to add or think that I have missed

Question 2

How to do an abdominal examination

Answer 2

WIPER

• wash hands
• introduce yourself
• permissions and pain
• expose the patient
• reposition the patient lying down at a 45 degree angle
• as the patient gets on the bed look for any discomfort
• look for signs of jaundice and abdominal distention
• look for catheters and other things around the bed

hands

• look for clubning
• leukonychia
• kolionychia
• palmar erythema
• dupuytren’s contratures
• pulse - rate, rhythm, character
• if the patient is jaundice and you suspect a liver failure check for a flap - carbon dioxide retention

Eye inspection

• conjuctiva palor - anemia
• yellow sclera for jaundice

Mouth

• ulcers
• dehydration
• tongue disorders - ask them to stick out there tongue

Lymph node palpitation

• supraclavicular nodes need to be particular palpated
• virchows node - left supraclavicular node that is enlarged in GI malignancy

abdominal inspection

• ask them to lie flat
• exposed from above the costal margins to the groin
• hands by the side
• ask them to lift up the top

inspect the abdomen for

• scars
• asymmetry
• distention
• dilated veins
• visible peristalsis

abdominal palpation

• ask them If they have any pain anywhere
• palpate all 9 areas first superficially and then deeply
• not that the correct position is at the same level as the patient so you are able to watch her face to see if she is in any pain
• test rebound tenderness for pressing in deeply

organ palpitation

• liver - ask them to take a few breaths in and out - move upwards pressing in as the patient inhales
• percuss the liver to assess its size
• spleen - start palpitation in the right lilac fossa and move diagonally to the left hyochodnrium
• percuss the spleen

kidneys

• place the left hand under the left loin and right hand in front and try to feel the kidney between your hands
• not normally palable

ascites
- shifting dullness and fluid thrill

percuss all 9 areas - leave the tender ones till last

auscultation
- usually listen in the right iliac fossa

complete

• hernial orficies
• external gentalia
• rectal examination