Abdominal Palpation

Question 1

Prior to physical exam, what should you obtain from the patient/owner

Answer 1

GDV) and obstruction due to foreign bodies, require prompt diagnosis and treatment.

Prior to examination, a relevant history, including signalment (age, breed, gender), should be obtained. Breed predispositions, e.g. GDV in German Shepherd Dogs and Feline Infectious Peritonitis (F.I.P) in Persians may be relevant. Information on worming prophylaxis, including product and frequency, and access to toxins should be sought. Lifestyle, recent dietary changes and previous medical history including any current medication (e.g. the old Labrador on NSAIDs) should be discussed. The importance of signalment, history and physical examination cannot be emphasised enough in this module.

Question 2

What is the first step in approach to a physical/clinical exam?

Answer 2

1. Briefly observe from a distance- BCS, behaviour, breathing pattern demeanour and changes in symmetry (in particular the head and abdomen) With GI cases you may need to watch a patient defaecating or see if the owners are able to record odd behaviour if they are unsure if their pet is coughing, retching, gagging, regurgitating, vomiting…it isn’t always easy!

Question 3

When looking at the oral cavity and head, what should you look at?

Answer 3

Oral cavity (and head)

1. MM colour and CRT (salmon pink and <2s) – look for evidence of dehydration (tacky mm/ prolonged CRT), shock, anaemia and/or jaundice
2. Open the mouth and examine both sides. Examine the tongue, palate, buccal and lingual gums and teeth, and the pharynx. Look for evidence of ulceration, periodontal disease, halitosis, neoplasia and/or foreign bodies-check under the tongue and the roof of the mouth
3. Carefully palpate the face for pain and/or swelling (including the orbit).
4. Palpate the lymph nodes (mandibular, superficial cervical) for enlargement or nodes that might feel firm or irregular e.g. signs of inflammation/infection/neoplasia. Make sure you can differentiate between salivary glands and lymph nodes.
5. Examine the nose and external nares for any nasal discharge
6. CATS: Try to palpate the thyroid glands (normal glands aren’t usually palpable. Abnormal glands are often mobile and sit either side of the trachea or dorsal to the trachea anywhere between the larynx and the thoracic inlet. If you are familiar with how the normal thyroid region feels, it will be easier to detect an abnormality when it’s present.)

Question 4

When examining the oesophagus, what should you do?

Answer 4

Oesophagus. Palpate the cervical region to detect any evidence of oesophageal pain (gulping/gagging) or swelling/foreign body. Examination of the oesophagus is otherwise very limited and restricted mainly to detecting consequences of oesophageal disease –for example auscultation of the thorax in cases of aspiration pneumonia in patients with megaoesphagus

Question 5

How should you palpate the abdomen?

Answer 5

Abdomen: It’s normal to try to palpate all the abdominal organs but don’t expect to feel everything –very often you won’t be able to. A working knowledge of organ topography is required (See dog colouring atlas). Palpation is easier in cats than dogs. It takes time to complete a useful examination of the abdomen and to be sure you have palpated as many of the organs as you can.

Abnormalities such as organomegaly, masses and fluid may be detected on palpation but are easy to miss especially if you don’t know what normal feels like- keep practising!Boarding due to pain and other reactions need to be differentiated from ‘normal’ reactions to examination.In large or overweight dogs, or nervous animals where tensing of the abdomen occurs, it won’t be possible to feel every organ. Deep chested dogs can also be challenging to palpate. From your knowledge of anatomy have a realistic idea about what you are likely to be able to feel (for example the spleen in a skinny Shih Tzu) as well as what you are highly unlikely to feel (for example the right kidney in a chunky Rottweiler). Gastric palpation is usually impossible, particularly when empty. You will never feel a normal pancreas in a dog or cat.

Dividing the abdomen into 6 sections, as illustrated below, can be useful for localising abnormalities. A knowledge of which structures normally lie there can help identify the potential source of any abnormality.This can be particularly useful as a novice, when identifying different organs can be challenging.

Question 6

What is the technique for abdominal palpation in a dog?

Answer 6

1. DOG: Stand behind the animal with the patient standing also. Place both hands on the caudal ribs then trace your hands caudally off the ribs and feel for subtle changes in pressure as different organs are palpated in the following cranial to caudal process

(Liver –> Stomach –> Spleen –> Kidneys –> SI –> Bladder –> Uterus/Prostate –> Colon)

Question 7

How can you examine the small intestine in a dog?

Answer 7

To examine the small intestine, spread the fingers and palpate cranially to caudally, then ventrally to dorsally, allowing the loops to slip through the fingers, minimising the risk of missing a foreign body, mass or intussusception. You may gain an impression of wall thickness and identify gas, fluid or hard faeces. Even very skilled and experienced clinicians will often not be able to rule out problems such as a foreign body on palpation alone. Abdominal palpation and diagnostic imaging are often complementary investigations. The decision to proceed with diagnostic imaging is however always based on the clinical history and full physical examination findings.

Question 8

How can you examin the baldder, colon and uterus/prostate in a dog?

Answer 8

Examination of the bladder, colon and uterus/prostate is best performed from the pelvic inlet forwards. The uterus is rarely palpable in a normal bitch. The prostate is likely to be intrapelvic in young or castrated dogs and therefore not detectable on abdominal palpation.

Question 9

How can you examine the abdomen of a cat?

Answer 9

CATS: A single hand may be used to palpate the organs in the same way. Many organs (for example the right kidney) are much easier to palpate in the cat than the dog.

1. Perineal and Rectal Examination- you should try to become very familiar with this during your EMS placements. Practice when you can, for example ask if you can do a rectal on anaesthetised patients- you could offer to empty the anal sacs at the same time….
   
   1. Take the temperature (38.3- 38.9 °C)- can be higher in excited/anxious patients!
   2. Examine the perineal region and perform a rectal exam. Identify the anal sacs which are located at 4 & 8 o’clock relative to the anus. The rectal exam is an important part of any physical examination and is used to assess the anal sphincter, rectal wall, local lymph nodes, prostate and urethra. With experience it should be possible to rule out a perineal hernia, anal sac disease and other problems including rectal strictures or polyps/mass lesions. If you don’t know what normal feels like, you will never recognise abnormal.
   3. Examine faecal consistency and colour (take a sample?-never miss an opportunity in case you decide later you should have collected one!- you can always bin it).