Abdominal Exam

Wash Hands
Introduce
Patients Name
Explain Procedure
Consent
Expose Patient
Position Supine, hands by side
Inspect
Patients comfort at rest
Surroundins
Nutritional State
!istension
S"in Colour
Scars
!eformities
Stoma #a
$ynaecomastia
Caput %edusa
Spider Nae&i '()*
Hands
%etabolic +lap
Spider Nae&i
Clubbin
,oylincihia 'spoon shape*
-euconychia '-iht Colour*
!upuytrens Contracture
Pale Palmar Crease
Palmar Erythema
Pulses
.adial .ate/.hythm/Character
Face
0anthalasma
Con1uncti&al Pallor
Scleral 2aundice
Smooth, #eefy 3onue
4lceration in mouth
5nular Stomatitis
Palpate
5s" about pain location
-ihtly throuhout 'painful area
last*
!eep throuhout
$uardin/.ebound 3enderness
-i&er 'chane position on
expiration*
Percuss chest to de6ne upper
marin
$all #ladder palpatin on
inspiration causes uardin
Spleen
-eft ,idney
.iht ,idney
Percuss Shiftin !ullness
Auscultate
#o7el Sounds 'min8 9 minute*
5ortic #ruits
.enal #ruits 'renal artery
stenosis*
Extras
P./P:
External $enitalia
Inuinal .eions hernia/lymph
nodes
-eft supracla&icular node
Virchows node (abdo cancer
Stomach in particular)
Close
3han" Patient
Wash Hands
Overall
4 # S %
Hernia Exam
Wash Hands
Introduce
Patients Name
Explain Procedure
Consent
Expose Patient
Position Standin
Inspect
S7ellins
Scars
Palpate
5s" patient to couh
+eel for couh impulse
5s" patient to reduce
5ttempt reduction
Co&er external rin and as" for
couh
Chec" contralateral side
If applicable: Scrotum
examination
Chaperone
Palpate testis for size/shape etc
Attempt to get aboe lump
!ransilluminate
Close
Would li"e to examine abdomen
%ichael Smith ;<9<
Abdominal Exam
3han" Patient
Wash Hands
%ichael Smith ;<9<
Abdominal Exam
Questions
Ho7 many spider nae&i need to be
present to be clinically sini6cant=
"#
What are the four types of causes in
dysphaia=
$ral e%g% mouth ulcers
&eurological e%g% bulbar
pals'
&euromuscular Phar'ngeal
Pouch
(echanical $esophageal Ca%
What is the name for blood in &omit=
)aematemesis
What is a di>erential for
Haematemesis=
Peptic *lcer
$esophageal aracies
(allor'+,eiss tear
-astric Cancer
What are the causes of pancreatitis=
Gallstones
Alcohol these two ma.e up /01
!rauma
Steroids
(umps
Autoimmune
Scorpion 2ite
)'pocalcaemia
34CP
5rugs
What le&els of biliruben are needed
for 1aundice to be clinically &isible=
"#0 micromol/l
What are the causes of abdominal
distension=
6at
6latus
6aeces
6luid (ascities)
6oetus
What does a metabolic ?ap indicate=
)epatic 3ncephalopath'
,ernic.e+7orsa.o8 S'ndrome
What does leuconychia indicate=
)'poalbuminaemia
What does "oylincihia indicate=
9ron 5e:cienc'
What is !upuytrens contracture and
7hat does it indicate=
Palmar 6ascia thic.ening
;ier Cirrhosis
&othing often idiopathic with
genetic element
What does a beefy smooth tonue
'lossitis* indicate in this context=
9ron de:cienc' /Pernicious anaemia
What causes anular stomatits=
Anaemia
What causes spider nae&i=
3leated oestrogen due to lier
damage
What 7ould be the hihest le&el 'rib*
youd expect to palpate the upper
li&er ede=
<
th
/#
th
What is %urphys sin and 7hat does
it indicate=
Place hand gentl' oer the gall
bladder= as. pt to inspire% !est is
positie if the pt winces with pain on
inspiration% Positie in cholec'stitis%
What is the di>erence bet7een
uardin, rebound tenderness and a
riid abdomen=
Guarding (uscle tensing due to
pain on pressure
Rebound Tenderness pain on
remoal of pressure due to
aggraation of parietal peritoneum
Ridged Abdomen 9ndicates
peritonitis
What 7ould you expect 7ith rebound
tenderness o&er the .-@=
Appendicitis
What 7ould you expect 7ith
uardin in the --@=
5ierticulitis
%ichael Smith ;<9<