Abdominal examination

1. Wash hands
2. Introduce self, identify patient’s name and age
3. I would like to examine your abdomen; involved looking,
feeling and listening to your it, is that ok?
4. Any pain at all?
5. Top off, pants lowered to suprapubic;- ideally nipple to knee:
patient supine, hands by side, legs uncrossed.

Inspection

1. Patient’s comfort: are you comfortable there?

2. Surroundings: O2 mask, special food, diabetic diet, stoma bag,
catheter
3. Patient’s appearance:
a. Moderately built?
b. Generally well/unwell?
c. Dehydrated? Malnourished? Cachexic?
d. Normal skin colour?
e. Scars/deformities?
f. Abdominal distension?
g. Gynaecomastia
h. Caput medusa
i. Spider naevi
4. Abdomen is symmetrical and moves equally on respiration
5. Cough for hernia

Hands

1. Warm, moist and well-perfused

2. Dorsum: Koilonychia, leuconychia, clubbing
3. Palmar: Palmar erythema, pale palmar creases, Dupuytren’s
contacture
4. Metabolic flapping tremor

Radial pulse for rate, rhythm, character

Scratch marks, bruising on arms

Head and neck

1. Eyes: Conjunctival pallor, scleral jaundice, xanthelasma

2. Lips, tongue: dry tongue, angular stomatitis, glossitis, ulcers
3. JVP
4. Lymph nodes from the front: supraclavicular
Palpation

1. Where is the pain again? Start away from pain

2. Superficial/deep palpation: from R iliac fossa
a. Guarding, rebound tenderness?
b. Masses?
3. Liver and gallbladder + spleen (breath in/out)
4. Kidneys balloting (breath in)

Percussion

1. Any masses
2. Liver and spleen
3. Shifting dullness if indicated

Auscultation

1. BSN (ideally 1 minute)

2. No aortic/renal bruits
Thank patient, cover patient, wash hands

Completion

1. PR/PV
2. External genitalia
3. Hernial orifices

Summarise

1. Name, gender, age

2. On abdominal examination he/she was generally well, not
dehydrated/malnourished
3. Normal colour
4. Abdomen appeared normal with no scars/ascites/distension
5. No peripheral stigmata of abdominal diseases
6. Radial pulse:
7. No organomegaly
8. Abdominen is SNT
9. BSN, no bruits
Questions What does a metabolic flap
indicate?
How many spider naevi need to Hepatic Encephalopathy
be present to be clinically Wernicke-Korsakoff Syndrome
significant?
>5
What does leuconychia indicate?
What are the four types of causes Hypoalbuminaemia
in dysphagia?
• Oral – e.g. mouth ulcers What does koylincihia indicate?
• Neurological – e.g. bulbar Iron Deficiency
palsy
• Neuromuscular – Pharyngeal What is Dupuytrens contracture
Pouch and what does it indicate?
• Mechanical – Oesophageal Ca. Palmar Fascia thickening
Liver Cirrhosis
What is the name for blood in Nothing – often idiopathic with
vomit? genetic element
Haematemesis
What does a beefy smooth
What is a differential for tongue (glossitis) indicate in this
Haematemesis? context?
• Peptic Ulcer Iron deficiency /Pernicious
• Oesophageal varacies anaemia
• Mallory-Weiss tear
• Gastric Cancer What causes angular stomatits?
Anaemia
What are the causes of
pancreatitis? What causes spider naevi?
Gallstones Elevated oestrogen due to liver
Alcohol – these two make up damage
80%
Trauma What would be the highest level
Steroids (rib) you’d expect to palpate the
Mumps upper liver edge?
Autoimmune 4th/5th
Scorpion Bite
Hypocalcaemia What is Murphy’s sign and what
ERCP does it indicate?
Drugs Place hand gently over the gall
bladder, ask pt to inspire. Test is
What levels of biliruben are positive if the pt winces with pain
needed for jaundice to be on inspiration. Positive in
clinically visible? cholecystitis.
>50 micromol/l
What is the difference between
What are the causes of abdominal guarding, rebound tenderness
distension? and a rigid abdomen?
Fat Guarding – Muscle tensing due
Flatus to pain on pressure
Faeces Rebound Tenderness – pain on
Fluid (ascities) removal of pressure due to
Foetus 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