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ABDOMINAL EXAMINATION:

WIPE + GA + VS + HANDS & ARMS+ HEAD + NECK+ CHEST + ABDOMEN + GROIN + LOWER EXTREMITIES +OTHERS
+ TSDR

WIPE
 Hi, I’m Dr. _______. I am the GP in this clinic. Today, I will do a physical examination of your tummy. I’m gonna
have a look, feel, listen and ask you to do some movement, is that alright with you?
 Can you please expose your tummy while I wash my hand?
 During my examination, if you feel uncomfortable, please feel free to stop me.
 Can you please lie down on the bed?
GA
 The patient’s lying comfortably. There’s no jaundice, skin pigmentation or xanthomata. He is conscious and
coherent.
1) Jaundice (liver disease)
2) Skin pigmentation (haemachromatosis)
3) Xanthomata (chronic cholestasis)
4) Mentals state (encephalopathy)
VS
 May I know the vital sign of my patient? Is his pulse regular? What is the O2 sat?
HANDS & ARMS
 Can you please show me your hands? Comparing both hands, there were no leuconychia and no clubbing.
 Can you please turn over your hands? There’s no erythema or dupuytren’s contracture.
 Can you please raise you arm like this? And bend your wrist upwards and hold it there for 15 seconds. No
hepatic flap seen.
1. Leuconychia: hypoalbuminemia, chronic liver disease
2. Nail clubbing
3. Palm: no erythema: CLD and dupuytren contracture: alcohol
4. Hepatic flap: extend wrist for 15 seconds: encephalopathy
 On inspection of the arm, there were no bruising, scratch marks, spider nevi. The pulses were equal and
normal.
 I would like to take the blood pressure of my patient.
1. Bruising: clotting problem, CLD
2. Scratch marks (Chronic cholestasis)
3. Spider nevi (liver cirrhosis, pregnancy)
4. Pulse
5. Blood pressure

HEAD
 Can you please lower down you eyelid and look up, then down? On inspection, there are no icteric sclerae or
pallor. No Kayser Fleisher ring seen.
 No fetor hepaticus breathe, no ulceration of the lip.
 Can you please open you mouth, there were no gum bleeding and tongue ulcer.
1. EYE
a. Jaundice sclerae
b. Anemia
c. Kayser Fleisher ring: Wilson’s disease
2. MOUTH
a. Fetor hepaticus
b. Lip ulceration
c. Gum bleeding
d. Tongue ulcer
NECK
1. Cervical and axillary lymph nodes
 Cervical and axillary lymph nodes were not palpable.
2. JVP
 On inspection, the jugular venous pulse is not visible.
a. Look: height and waveform
CHEST
 On inspection of the chest, there were no gynecomastia, spider nevi.
1) Gynecomastia
2) Spider nevi
3) Body hair
ABDOMEN
 Can you please lie flat in bed? I will examine your tummy.
1. Inspect
 On inspection, there are no scars, distention, swelling, prominent veins, stria and flanck discoloration seen.
a. Scars
b. Distension/ local swelling
c. Prominent veins
d. Striae
e. Flank discoloration
2. Palpate
 On palpation, there are no tenderness, rigidity and masses felt.
 There are no hepatomegaly and splenomegaly. No masses palpated on kidneys.
a. Superficial: tenderness, rigidity and masses
b. Deeper: liver, spleen, kidney, masses
 On percussion, there is no shifting dullness.
3. Percuss
a. Liver
b. Spleen
c. Ascites: shifting dullness: percuss to left flank dullness then roll to the right
4. Auscultate
 On auscultation, the bowel sounds are normal, no hum. There were no aortic and renal artery bruits.
a. Bowel sound
b. Bruits
c. Hum: portal hypertension
GROIN
 I would like to examine the hernia orifices, testis and the inguinal lymph nodes for masses.
1) Hernia
2) Lymph nodes
3) Testis
LOWER EXTREMITIES
 Comparing both legs, there are no swelling and bruising.
1. LOOK: bruising
2. Edema
3. Neurological sign (alcohol)
OTHERS
 To complete my examination, I would like to do rectal examination and do a urine dipstick test. I would also
like to check the temperature chart.
1. Rectal exam
2. UA
3. Temperature chart
TSDR
 Thank you so much.

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