Abdominal Examination

I would like to complete my Examination by:

 Taking detailed history
 Check the observation chart
 Examine the hernia orifices and external genitalia.
 And do the DRE
Sir, I have examined the lady. She is –
 Cachectic
 There is no evidence of Anemia, Lymphadenopathy, Stigmata of CLD.
 In the hands, There is evidence of:
 Clubbing
 Leukonychia, Koilonychias.
 Palmar erythema
 Dupuytren’s contracture.
 Flapping tremor.
 In the arms, There is evidence of-
 Scar marks and bruising.
 Xanthoma.
 On Further examination, there is evidence of-
 Multiple spider nevi on chest
 There is gynecomastia and loss of body hair
On examination of the abdomen:
 The abdomen is distended, Flanks are full and umbilicus is everted.
 Abdomen is soft and non-tender, no evidence of prominent vein
 There is evidence/no evidence of hepatosplenomegaly
 Liver is enlarged, 4cm from right costal margin in the midclavicular line
 Non-tender, firm in consistency
 Margin is sharp/regular with smooth surface.
 Spleen is enlarged, 2 cm from the left costal margin towards the RIF in the anterior axillary line.
There is clinically detectable ascites as evidenced by shifting dullness, Fluid thrill is absent Bowel sounds
are present, there are no audible bruit.

APPROACH IN ABDOMEN STATION

 Hi, I am dr. Talukder, a medical officer working in this clinic

 Am I talking with mr. X, 30 years of age?
 I have been asked to examine your chest. is that alright?)
 Can you please remove your tops/shirt/gown please)
 Do you have any pain or discomfort anywhere?
 If you get uncomfortable or feel any pain, just let me know. I will be more gentle

GENERAL INSPECTION (at 45)

 At first, I am going to have a good look at you from the end of the bed
 - Body built (malnourished, well nourished, obese)
- Abnormal facies
- Visible jaundice
- Gynaecomastia
- Pigmentation
 Can you take a deep breath in and out for me please?
 Give a cough for me please, Thank you
 Do you have any pain in your legs? I'm going to press on those gently- Pedal edema

HAND

 Now I'm going to check your hands. Do you have any pain in your hands? Can you
please place your hands like this?
- Clubbing
- Cyanosis
- Leuconychia
- Koilonychia
 Now turn your hand like this- palm upward (Palmar erythema)
- Palmar erythema
- Dupuytren's contracture (feel with the thumb)
 Please, cock your wrist back- Flapping tremor
 Now I am going to check for your pulse- Rate, rhythm, character, volume
 Also look for Skin marks, AVF

FACE EXAMINATION

 Observe for hepatic facies, parotid enlargement

 Now I'm going to check your eye, is that alright?
 Xanthelasma, corneal arcus, KF ring
 Please look upward- Anaemia
 Please look downward- Jaundice
 MOUTH-
 Can you open your mouth wide for me please- check with torch
 Can you stick out your tongue; now roll it over
 Can you please show me your gum like this? - Gum hypertrophy
NECK

 Now I'm going to check your neck, is that alright?

 Please turn your face to the left. Check for- JVP (Check HJR)
 Do you have any pain in your tummy? I'm going to press it gently. If you feel any
pain/discomfort, please let me know- Press and hold gently but firmly for 10s
 Can you please sit forward for me
- Back for scar mark, pigmentation
- Now I'm going to feel your neck- Neck LN
- (sacral edema)

CHEST

Now I am going to check your chest- check for Hair loss, Gynecomastia, Spider nevi

ABDOMEN PALPATION

Now I am going to examine your tummy. Do you have any tummy pain? Please let me
know if you feel any pain or discomfort.

 Inspection- First of all, I am going to have a close look at your tummy

 Palpation-
 Now I am going to feel your tummy gently
 I am going to press on your tummy more deeply.
 Please turn your face to the left. Please take deep breath in and out for me.
 Take deep breath in …… and out…. And in…Ok thank you
 Now, I am going to check your spleen….. Again please take deep breath in
and out for me
 If spleen not palpable, please make half turn towards me
 If liver and spleen palpable, percuss over it
 Now, I am going to check for your kidney
 Percussion-
 Now I am going to tap on your tummy
 Fluid thrill- Can you please place your hand over your tummy like this firmly
 Then do shifting dullness
 Auscultation- I am going to listen your tummy

CLOSURE
I have completed my examination. Thank you very much for letting me examine you.
You can get dressed now. I would like to complete my examination by-
 Taking detailed history
 Check the observation chart
 Examine the hernia orifices and external genitalia.
 And do the DRE