Abdominal Exam

Wash Hands
Introduce
Patients Name
Explain Procedure
Consent
Expose Patient
Position Supine, hands by side

Right Kidney
Percuss Shifting Dullness

Inspect

Extras

Patients comfort at rest

Surroundings
Nutritional State
Distension
Skin Colour
Scars
Deformities
Stoma Bag
Gynaecomastia
Caput Medusa
Spider Naevi (>5)

Auscultate
Bowel Sounds (min. 1 minute)
Aortic Bruits
Renal Bruits (renal artery
stenosis)
PR/PV
External Genitalia
Inguinal Regions hernia/lymph
nodes
Left supraclavicular node
Virchows node (abdo cancer
Stomach in particular)

Close
Thank Patient
Wash Hands

Hands

Overall

Metabolic Flap
Spider Naevi
Clubbing
Koylincihia (spoon shape)
Leuconychia (Light Colour)
Dupuytrens Contracture
Pale Palmar Crease
Palmar Erythema

Pulses
Radial Rate/Rhythm/Character

Face
Xanthalasma
Conjunctival Pallor
Scleral Jaundice
Smooth, Beefy Tongue
Ulceration in mouth
Angular Stomatitis

Palpate
Ask about pain location
Lightly throughout (painful area
last)
Deep throughout
Guarding/Rebound Tenderness
Liver (change position on
expiration)
Percuss chest to define upper
margin
Gall Bladder palpating on
inspiration causes guarding
Spleen
Left Kidney

Hernia Exam
Wash Hands
Introduce
Patients Name
Explain Procedure
Consent
Expose Patient
Position Standing

Inspect
Swellings
Scars

Palpate
Ask patient to cough
Feel for cough impulse
Ask patient to reduce
Attempt reduction
Cover external ring and ask for
cough
Check contralateral side
If applicable: Scrotum
examination
Chaperone
Palpate testis for size/shape etc
Attempt to get above lump
Transilluminate

Close
Would like to examine abdomen

Michael Smith 2010

Abdominal Exam
Thank Patient
Wash Hands

Michael Smith 2010

Abdominal Exam
Questions
How many spider naevi need to be
present to be clinically significant?
>5
What are the four types of causes in
dysphagia?

Oral e.g. mouth ulcers

Neurological e.g. bulbar

palsy

Neuromuscular Pharyngeal
Pouch

Mechanical Oesophageal Ca.

What is the name for blood in vomit?
Haematemesis
What is a differential for
Haematemesis?

Peptic Ulcer

Oesophageal varacies

Mallory-Weiss tear

Gastric Cancer
What are the causes of pancreatitis?
Gallstones
Alcohol these two make up 80%
Trauma
Steroids
Mumps
Autoimmune
Scorpion Bite
Hypocalcaemia
ERCP
Drugs
What levels of biliruben are needed
for jaundice to be clinically visible?
>50 micromol/l
What are the causes of abdominal
distension?
Fat
Flatus
Faeces
Fluid (ascities)
Foetus
What does a metabolic flap indicate?
Hepatic Encephalopathy
Wernicke-Korsakoff Syndrome

What is Dupuytrens contracture and

what does it indicate?
Palmar Fascia thickening
Liver Cirrhosis
Nothing often idiopathic with
genetic element
What does a beefy smooth tongue
(glossitis) indicate in this context?
Iron deficiency /Pernicious anaemia
What causes angular stomatits?
Anaemia
What causes spider naevi?
Elevated oestrogen due to liver
damage
What would be the highest level (rib)
youd expect to palpate the upper
liver edge?
4th/5th
What is Murphys sign and what does
it indicate?
Place hand gently over the gall
bladder, ask pt to inspire. Test is
positive if the pt winces with pain on
inspiration. Positive in cholecystitis.
What is the difference between
guarding, rebound tenderness and a
rigid abdomen?
Guarding Muscle tensing due to
pain on pressure
Rebound Tenderness pain on
removal of pressure due to
aggravation of parietal peritoneum
Ridged Abdomen Indicates
peritonitis
What would you expect with rebound
tenderness over the RLQ?
Appendicitis
What would you expect with
guarding in the LLQ?
Diverticulitis

What does leuconychia indicate?

Hypoalbuminaemia
What does koylincihia indicate?
Iron Deficiency

Michael Smith 2010