ABDOMINALEXAM

DATE:_____________

___1.
GENERAL.(W)Washyourhands.
___2.
(I)Introduceyourselfandstandtotheright
___3.
(P)Permission.Askthemtotellyouifpainoccurs.Positionthepatientsupinewith
armsatsideorfoldedacrosschest,withonelowpillow.
___4.
(E)Expose.Bringsheetupfrombelow,exposingbelowthesymphsispubisand
lift/removethegownabovethexiphoidprocessandcostalmargins.
___5.
PERIPHERALEXAM.Cachexia,Jaundice(liverdisease),Pigmentation
(haemochromatosis),restlessness,drowsiness(encephalopathy).
___6.
Inspecthandsfor:clubbing,leuconychia(chronicliverdisease),palmarerythema,
contractures/thickeningoftheflexortendons(Dupuytrenscontractures),andaskthemtohold
therewristsinextensionfor30seconds(hepaticflaporasterixis)
___7.
Inspectarmsfor:scratchmarks(cholestasis),bruising,spidernaevi>5
___8.
Inspectfacefor:Scleralicterus,conjunctivalpallor(anaemia),iritis,Kayser
Fleischerrings(Wilsonsdisease);xanthelasma(chroniccholestasiseg.PBC),cornealarcus
(hyperlipidaemia),parotidswelling(alcoholabuse)
___9.
Inspectmouthfor:pigmentation(PeutzJeghers),telangiectasia(HHT),fetor
hepaticus(asweetsmell),alcohol,angularcheilitis(irondeficiency),aphthousulcers
(Crohns),macroglossia,red/beefyglossitis(folate/B12deficiency)oratrophicandsmooth
tongue(irondeficiency)
___10.
Inspectneck/chestfor:supraclavicular/cervicalnodes(standingbehindthepatient
askingthemtoshrugandrelaxshoulders;leftsidedVirchowNodesuggestsgastricca.),
axillarynodes(holdingthepatientsarmsattheside);andoccipital/pre/post
auricular/submandibular/submentallymphnodes
___11.
ABDOMINALINSPECTION.all4quadrantsandepigastricareasystematically.
Describetheskin(scars,rashes,lesions,caput,venousdilatation,spiderangiomata).
___12.
Contourofthecentralabdomen(Flat,rounded,protuberant,distendedorscaphoid)
___13.
Symmetry(orlackthereofduetomassesororganenlargementcausingafocal
protuberance)
___14.
Visiblepulsations(Particularlyaorticpulsationsintheupperabdomen)
___15.
PALPATION.Palpateeachquadrantoftheabdomenlightlytodetecttenderness,
muscularspasm,orrigidity.
___16.
Palpateeachquadrantoftheabdomendeeply,notinganyofthefollowing:
tenderness,masses,pulsations,palpablebowelloops,rushesormovement.Trytoexamine
withthepatientsrespiratoryflow,andbesuretopalpatetenderareaslast(andgently).
___17.
Identifythebottomedgeoftheliver.(StartatRLQ)Beginpalpatingbelowthelower
edgeidentifiedbypercussion,andworkyourwaysuperiorly.Scratchtestisacceptable.
Remember,therightlobeofthelivercomesdownlowerthantheleftlobe
___18.
Palpateinthemidabdominalregionforanaorticaneurysm(i.e.,apulsatilemass)
___19.
Palpatingthespleen:Normallythespleenisnotpalpable.Agoodscreenistopercuss
alongtheleftsideoftheabdomen.Ifnodullnessisnoted,thespleenisunlikelytobe
enlarged.Toconfirmyourfindings,palpatetheleftupperquadrantdeeplyinboththesupine
position,andwiththepatientrestingonhis/herrightside.
___20.
Feelforinguinalhernias(alsostandingup)
___21.
PERCUSSION.Percussabdomen.(Painfuliftheperitoneumisirritated)
___22.
Percussoverthesuprapubicarea.(Willbedullifbladderisdistended)
___23.
Assesstopandbottomedgesofliver(inmidclavicularline)bypercussion,andnote
liverspanincentimeters.
___24.
AUSCULTATION.Describecharacter(e.g.,highpitched,tinkling,rushes,
rumbling)Thetermborborygmi(rumbling,gurgling,tinklingnoisesheardonauscultation
oftheabdomeninconditionsofincreasedintestinalperistalsis)issometimesused
___25.
Listeninthemidepigastrumforabdominalaorticbruits.
___26.
Listenontheleftandrightsidesoftheepigastrumforrenalarterybruits.
___27.
Listenoverthefemoralarteriesforfemoralbruits.
___28.
MentionaPRExam.Fistula,tags,blood,mucus,melaena,masses

Timetaken:___minutes

Timegiven:7minutes

Acuteabdominalpainshouldinclude:

Symptoms. Site, Onset, Character, Radiation, Associated

symptoms, Timing, Exacerbating and Relieving factors,
Severity

Associations: dysuria, diarrhoea, nausea, vomiting

Referred pain. Epigastrium foregut - Gives rise to

oesophagus, stomach, proximal duodenum, liver, gallbladder,
pancreas, spleen

Umbilical region - midgut Gives rise to distal duodenum,

jejunum, ileum, caecum, appendix, ascending colon, proximal
2/3 of transverse colon

Suprapubic region - Hindgut - distal 1/3 of transverse colon,

descending colon, rectum and upper anal canal

RLQ appendicitis, colitis (older age group), renal colic

RUQ cholecystitis (murphys), cholangitis (particularly if

associated with jaundice), hepatitis (especially on background
of alcoholism)

Epigastric/central pancreatitis

LUQ no specific pathology, usually requires CT to

differentiate

LLQ diverticulitis, renal colic, ectopic pregnancy

Guarding at McBurneys point. This is the name given to the

point found 1/3 of the distance between the right anterior superior
iliac spine and the umbilicus.
Rovsings sign. If palpation of the LLQ increases the pain felt in the
RLQ the patient is said to be Rovsings positive.
Psoas sign. Flex the right hip joint and rotate it internally and
externally. If this results in pain at the RLQ, the patient is said to be
Psoas positive
Child-bearing female BHCG
Male Check the testes

Also: UA, signs of CCF

L/RHypochondrium
Epigastrium
R/LLumbar
Umbilical
RIF/LIF
Hypogastrium