7/23/2019 Abdominally Exam Date
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ABDOMINAL EXAM DATE: _____________
___ 1. GENERAL. (W) Wash your hands.
___ 2. (I)Introduce yourself and stand to the right
___ 3. (P)Permission. Ask them to tell you if pain occurs.
Position the patient supine with
arms at side or folded across chest, with one low pillow.___ 4.
(E)Expose. Bring sheet up from below, exposing below the symphsis
pubis and
lift/remove the gown above the xiphoid process and costal
margins.
___ 5. PERIPHERAL EXAM. Cachexia, Jaundice (liver disease),
Pigmentation
(haemochromatosis), restlessness, drowsiness
(encephalopathy).
___ 6. Inspect hands for: clubbing, leuconychia (chronic liver
disease), palmar erythema,
contractures/thickening of the flexor tendons (Dupuytrens
contractures), and ask them to hold
there wrists in extension for 30 seconds (hepatic flap or
asterixis)
___ 7. Inspect arms for: scratch marks (cholestasis), bruising,
spider naevi >5
___ 8. Inspect face for: Scleral icterus, conjunctival pallor
(anaemia), iritis, Kayser-
Fleischer rings (Wilsons disease); xanthelasma (chronic
cholestasis eg. PBC), corneal arcus
(hyperlipidaemia), parotid swelling (alcohol abuse)
___ 9. Inspect mouth for: pigmentation (Peutz Jeghers),
telangiectasia (HHT), fetorhepaticus (a sweet smell), alcohol,
angular cheilitis (iron deficiency), aphthous ulcers
(Crohns), macroglossia, red/beefy glossitis (folate/B12
deficiency) or atrophic and smooth
tongue (iron deficiency)
___ 10. Inspect neck/chest for: supraclavicular/cervical nodes
(standing behind the patient
asking them to shrug and relax shoulders; left-sided Virchow
Node suggests gastric ca.),
axillary nodes (holding the patients arms at the side); and
occipital/pre/post-
auricular/submandibular/submental lymph nodes
___ 11. ABDOMINAL INSPECTION. all 4 quadrants and epigastric
area systematically.
Describe the skin (scars, rashes, lesions, caput, venous
dilatation, spider angiomata).
___ 12. Contour of the central abdomen (Flat, rounded,
protuberant, distended or scaphoid)
___ 13. Symmetry (or lack thereof due to masses or organ
enlargement causing a focal
protuberance)___ 14. Visible pulsations (Particularly aortic
pulsations in the upper abdomen)
___ 15. PALPATION.Palpate each quadrant of the abdomen lightly
to detect tenderness,
muscular spasm, or rigidity.
___ 16. Palpate each quadrant of the abdomen deeply, noting any
of the following:
tenderness, masses, pulsations, palpable bowel loops, rushes or
movement. Try to examine
with the patients respiratory flow, and be sure to palpate
tender areas last (and gently).
___ 17. Identify the bottom edge of the liver. (Start at RLQ)
Begin palpating below the lower
edge identified by percussion, and work your way superiorly.
Scratch test is acceptable.
Remember, the right lobe of the liver comes down lower than the
left lobe
___ 18. Palpate in the mid-abdominal region for an aortic
aneurysm (i.e., a pulsatile mass)
___ 19. Palpating the spleen: Normally the spleen is not
palpable. A good screen is to percuss
along the left side of the abdomen. If no dullness is noted, the
spleen is unlikely to be
enlarged. To confirm your findings, palpate the left upper
quadrant deeply in both the supine
position, and with the patient resting on his/her right
side.
___ 20. Feel for inguinal hernias (also standing up)
___ 21. PERCUSSION.Percuss abdomen. (Painful if the peritoneum
is irritated)
___ 22. Percuss over the suprapubic area. (Will be dull if
bladder is distended)
___ 23. Assess top and bottom edges of liver (in midclavicular
line) by percussion, and note
liver span in centimeters.
___ 24. AUSCULTATION. Describe character (e.g., high pitched,
tinkling, rushes,
rumbling) The term borborygmi (rumbling, gurgling, tinkling
noises heard on auscultation
of the abdomen in conditions of increased intestinal
peristalsis) is sometimes used
___ 25. Listen in the midepigastrum for abdominal aortic
bruits.
___ 26. Listen on the left and right sides of the epigastrum for
renal artery bruits.
___ 27. Listen over the femoral arteries for femoral bruits.___
28. Mention a PR Exam.Fistula, tags, blood, mucus, melaena,
masses
7/23/2019 Abdominally Exam Date
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Time taken: ___ minutes Time given: 7 minutes
Acute abdominal pain should include:
Symptoms. Site, Onset, Character, Radiation, Associatedsymptoms,
Timing, Exacerbating and Relieving factors,Severity
Associations: dysuria, diarrhoea, nausea, vomiting
Referred pain. Epigastrium foregut ! "ives rise tooesophagus,
stomach, proximal duodenum, liver, gallbladder,pancreas, spleen
#mbilical region ! midgut "ives rise to distal duodenum,$e$unum,
ileum, caecum, appendix, ascending colon, proximal%&' of
transverse colon
Suprapubic region ! (indgut ! distal )&' of transverse
colon,descending colon, rectum and upper anal canal
R*+ appendicitis, colitis older age group-, renal colic
R#+ cholecystitis murphys-, cholangitis particularly
ifassociated .ith $aundice-, hepatitis especially on bac/groundof
alcoholism-
Epigastric¢ral pancreatitis
*#+ no speci0c pathology, usually re1uires CT todi2erentiate
**+ diverticulitis, renal colic, ectopic pregnancy
Guarding at McBurneys point3 This is the name given to thepoint
found )&' of the distance bet.een the right anterior
superioriliac spine and the umbilicus3Rovsings sign3 4f palpation
of the **+ increases the pain felt in theR*+ the patient is said to
be Rovsing5s positive3Psoas sign3 6lex the right hip $oint and
rotate it internally andexternally3 4f this results in pain at the
R*+, the patient is said to be7soas positive
Child!bearing female 8(C"
9ale Chec/ the testes
