Abdominal Exams

Question 1

Introduction

Answer 1

INTRODUCTION:
• Greet the examiner.
• Greet the patient.
• Introduce yourself and establish rapport.
• Confirm patient’s identity.
• Briefly explain what the examination is about.
• Obtain consent.
• Ask for a chaperone
To the examiner:
I would like to:
• screen my patient for privacy.
• adequately expose my patient (e.g. from nipple line to mid-thigh).
• place my patient in an anatomical position (e.g. with the body su-
pine, the arms at the sides and the palms facing upwards).
• sanitize or wash my hands with running water and soap.
• Ask to perform a quick general examination.
• Points to note: Sclera jaundice, conjunctival pallor, peripheral cyano-
sis, finger clubbing, cervical lymphadenopathy, etc.

Question 2

Inspection of the abdomen what should we tell the patient to do and what should we inspect

Answer 2

INSPECTION:
Inspect the abdomen from the side to the foot of the bed. Points to note:
• Is the abdomen flat, scaphoid or distended?
• Does it move with respiration?
• Is umbilicus everted or inverted?
• Is the patient calm or restless?
• Is the patient obese or wasted?
• Are there scars, lumps, rashes, ulcers, dilated veins, etc.?
• Are there colostomy bags, gastrostomy tubes, Intravenous cannula,-
catheters, etc.?
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• Check for visible cough impulse from hernia orifices (ask the patient to turn head to the left).

Question 3

Palpation of abdomen

Answer 3

PALPATION
Before you proceed to palpate, ask for any area of tenderness. If any, ask patient to point with a finger.
Light palpation: start from the left iliac region, checking for tenderness (if there is pain, start away from the site of pain).
Deep palpation: repeat the same palpation but going deeper this time checking for masses.
Organ palpation:
Liver (hepatomegaly): begin by placing the right hand on the right iliac fossa and palpating upwards as the patient breaths in and out.
Spleen (Splenomegaly): starting from the right iliac fossa, palpate diagonally upwards to the projection of an enlarged spleen.
Kidney (hydronephrosis): ballot the kidney by placing the left hand behind the patient at the level of the 12th rib. Place your right hand on the abdomen at the right or left flank and palpate with these two hands, feeling for an enlarged kidney

Question 4

Percussion of abdomen what should we begin

Answer 4

Liver span:
• Start from the midclavicular line at the 2nd or 3rd intercostal space and percuss downwards until the point of dullness (upper border).
• Resume percussion from right iliac fossa upwards until the point of dullness (inferior border).
• Measure the liver span in centimeters (with the inch side facing you to avoid bias).
Ascites: Shifting dullness:
• Percuss from the umbilicus to the flank (about 3 zones), checking for dullness.
• Keep your finger on the spot and ask the patient to roll onto the opposite side.
• Keep the patient on this position for about 10seconds (to allow for fluid redistribution).
• Repeat the percussion, but this time towards the umbilicus.
• If the flank becomes resonant after a change in patient’s position, it is positive for ascites.

Question 5

Auscultation of the abdomen

Answer 5

• Bowel sounds: best heard at the Mcburney’s point.
• Aortic bruits: best heard above the umbilicus.
• Renal bruits: best heard above the umbilicus, slightly lateral to the midline.
• Hepatic bruits: best heard over the right upper quadrant.
Ask to perform a Digital Rectal Examination (DRE)
(The abdominal examination is not complete without a DRE)

Question 6

What are important signs we should know in acute appendicitis

Answer 6

. Pointing sign
• Rebound tenderness
•Rovsing sign
• Psoas sign
• Obturator sig

Question 7

what signs should we know in cholecystitis

Answer 7

.Murphy sign
• Boas sign

Question 8

Nephrolithiasis: which sign should we know

Answer 8

Pasternatsky

Question 9

Gastric Outlet Obstruction

Answer 9

Succussion splash