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AAK & SMD

ABDOMINAL EXAMINATION

SANITIZE HANDS

Hello my name is

And how old are you?

I’ve been asked to examine your abdomen, which would involve me looking at and feeling your hands, face and stomach. Is that ok?

and I am a

medical student. What’s your name?

General Inspection:

- Stand at the foot of the bed. Assess the patient’s state.

- On general inspection we have

a

comfortable and in no obvious distress.

He appears to be

- There appears to be no bruising, scars or rashes on his abdomen

- Normal hair distribution

- No spider naevi and no obvious masses seen

- No abdominal distention

- Press tibia for pedal oedema

- No pedal oedema

Hands:

-

Can I look at your hands. Hands are warm and moist

-

Look for palmer erythema.

-

No palmer erythema

-

Look for Dupuytren’s contracture.

-

No signs of Dupuytren’s Contracture

-

-

Nails:

a. Leukonychia: white nails, sign of hypoalbuminaemia No leukonychia

b. Koilonychia: spooning nails, signs of liver disease. No koilonychia

c. Clubbing: nail bed angle, nail bed fluctuance, Schamroth’s window test

Dupuytren’s contracture

No koilonychia c. Clubbing: nail bed angle, nail bed fluctuance, Sc hamroth’s window test Dupuytren’s contracture
No koilonychia c. Clubbing: nail bed angle, nail bed fluctuance, Sc hamroth’s window test Dupuytren’s contracture

AAK & SMD

AAK & SMD Nail bed angle : Can you put your hands flat and stick them

Nail bed angle:

Can you put your hands flat and stick them out for me. Look for loss of nail bed angle at eye level. No loss of the nail bed angle

Nail bed fluctuance:

Can I see your finger please. Hold patient’s finger at the joint closest to the finger tip, using the base of your thumbs and your middle fingers. Use your index fingers to gently rock the nail bed side to side. No nail bed fluctuance

rock the nail bed side to side. No nail bed fluctuance Schamroth’s window : Can you

Schamroth’s window:

Can you make two hooks with your fingers and bring them together (demonstrate). Schamroth’s window is preserved therefore no signs of clubbing

window is preserved therefore n o signs of clubbing - Asterixis: Can you hold your hands

-

Asterixis:

Can you hold your hands out like this for me. Demonstrate to the patient holding hands out with wrists cocked back. Check for flapping tremor. Indicative of CO 2 retention and liver failure. No signs of Asterixis

AAK & SMD

Face:

-

Eyes:

a. I am now going to examine your eyes. Can you look up please. Pull down the lower eyelid and look for conjunctival pallor (pink and moist mucous membranes). Look for signs of jaundice in the sclera. Mucous membranes appeared pink and moist/ no conjunctival pallor. No signs of jaundice/ no scleral icterus

b. Check for xantholasma around eyes (fatty deposits) No xantholasma present

-

Mouth:

a. Angular stomatitis. Look for hacks at the corners of the mouth. No signs of angular stomatitis

b. Can you open your mouth please. Check for: good dentition Glossitis (smooth, pale tongue iron deficiency) ulceration of mouth and throat leukoplakia (thick, white patches on the tongue and the lining of mouth) Good dentition, no glossitis, no leukoplakia, and no apparent mouth ulcerations

Neck:

a.

JVP (Jugular Venous Pressure):

-

Can you turn your head to the left please. Look for elevated JVP shining a penlight on the neck.

-

Do you have any pain in your tummy today? Ok I’m just going to press on it now. Hepatojugular reflex elicited and no elevated JVP

b.

Lymph Nodes:

-

Ideally I would palpate the lymph nodes.

-

OR

-

Now I’m just going to feel your neck. Palpate the lymph nodes. Pay particular attention to Virchow’s Node (gastric malignancy) No lymphadenopathy

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Closer Inspection of the abdomen:

- On closer inspection of the abdomen, findings were consistent with that at the foot of the bed.

- Look for hernia scars, distention, respiratory movement. No spider naevi No scars or discolourations No obvious masses seen No caput medusa, or abdominal distention

Spider Naevi
Spider Naevi

Palpation:

Now I am going to examine your abdomen. Are you in any pain today?

1.

Light palpation:

-

I’m just going to press lightly on your tummy now. If you feel any pain, let me know.

-

Squat to eye level of the patient’s abdomen and look at the face for any signs of discomfort while palpating.

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Palpate all 9 quadrants of the abdomen with light palpations.

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Note any pain, rebound tenderness and guarding.

2.

Deep palpations:

-

Now I’m going to press a little more deeply. Tell me if you feel any pain.

-

Repeat the palpations but press more deeply into the abdomen.

-

Note any palpable masses.

deeply into the abdomen. - Note any palpable masses. No rebound tenderness or guarding. No palpable

No rebound tenderness or guarding. No palpable masses.

Palpate organs:

1. Liver

2. Spleen

3. Kidneys

4. Check for ascites

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Liver:

- Using the radial border of the index finger, palpate the liver’s edge by starting in the right iliac region and moving up towards the coastal border.

- I am going to press into your right side now. Please take some deep breaths for me.

- Press in on inspiration and feel for the free edge of the liver

- A normal liver should not be palpated. No hepatomegaly observed

Spleen:

- Can you take some deep breaths for me again.

- Start from the right iliac region and palpate in increments towards the left costal margin.

- Press in on inspiration and feel for the enlarged spleen

- Can you turn to your right side for me. Place patients left arm on your left shoulder to support. Can you breathe in one more time.

- A normal spleen would not be palpated. No splenomegaly

Kidney:

- For each kidney, press down on the abdomen with the upper hand and ‘flick’ the kidney up with the lower hand, against the upper hand. Kidneys were not ballotable

Aorta:

against the upper hand. Kidneys were not ballotable Aorta: - Palpate the aorta along the midline

- Palpate the aorta along the midline above the umbilicus, with the tips of the fingers. No abnormal pulsations of the abdominal aorta and no masses.

AAK & SMD

Percussion:

1. Liver

2. Spleen

3. Ascites

Liver:

- Start in the right iliac region and move towards the costal margin.

- I am now going to tap lightly on your stomach now.

- Percuss upwards until the tone changes from resonant to dull (lower border of the liver)

- Ask patient to make the spot with their finger. Can you please place your finger here.

- Percuss from the upper border downwards until the tone changes from resonant to dull (upper border of the liver)

- Measure the distance between the upper and lower borders of the liver.

Liver measures

Spleen:

cm. No hepatomegaly

- Percuss from the right iliac region to the left costal margin

- Should be resonant throughout.

- Dullness indicates splenomegaly. No splenomegaly

Shifting dullness:

- Percuss the abdomen centrally to laterally on each side.

- When a dull tone is heard laterally, ask the patient to roll on their side. (The side opposite to the one you are percussing)

- Can you turn towards/away from me.

- Percuss the area again. It should be still dull. If it is resonant it suggests an ascites that might have shifted when the patient rolled over. No shifting dullness

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Fluid Thrill:

- Can you please place your hand in the middle of your abdomen.

- Place on hand flat on one side and lightly flick the other.

- Note any thrills felt which could indicate ascites. No fluid thrill therefore no ascites observed

ascites. No fluid thrill therefore no ascites observed Auscultation: - Now I am going to listen

Auscultation:

- Now I am going to listen to your stomach.

- Listen for bowel sounds at the ileocaecal valve, right lower quadrant.

- If not heard after 2 mins, indicates bowel sounds are absent.

- Listen for aortic and renal bruits Normal bowel sounds and no aortic or renal bruits heard

Normal bowel sounds and no aortic or renal bruits heard Thank you for your corporation COVER

Thank you for your corporation

COVER THE PATIENT.

On summary we have

distress. No evidence of hepatomegaly, splenomegaly or ascites were found. Findings were consistent with that of a normal abdominal examination.

To complete my exam, I would examine the external hernial orifices and do a digital rectal exam.

a

year old male/female, who was in no apparent