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Abdominal Examination


Should be able to detect

  • Enlarged/tender Gall Bladder
  • Hepatomegaly
  • Splenomegaly
  • Signs of liver disease
  • Upper Abdominal Mass
  • Ascites

General

  • hands
    • nails
    • palms
    • asterixis
  • eyes
    • sclera
    • conjunctiva
  • mouth
    • telangiectasia
    • perioral pigmentation
  • tongue
    • dehydration
    • coated
  • breath
    • ketosis
    • halitosis
  • lymph nodes
    • cervical
    • left supraclavicular fossa
  • chest
    • spider naevi
    • purpura
    • gynaecomastia

Inspection

  • routine
    • Patient comfortably supine, one or two pillows to relax abdomen, arms by sides
    • Expose between xiphisternum and pubis
    • Deep breath and cough
  • Shape and symmetry of abdomen
    • abdominal distension
  • movement with respiration
  • Scars
  • Note any other abnormalities
    • hernia
  • Tangentially look for peristalsis

Palpation

  • Warm hands
  • Patient places arms alongside body
  • Ask to report any tenderness
  • Observe face for grimace
  • Light Palpation
    • muscle tone
    • rebound tenderness
    • guarding
  • Deep palpation
    • palm of hand
    • dipping
  • Liver
    • edge sharp, rounded, firm, irregular, tender
    • normal 1-2cm below costal margin
  • Gallbladder
    • Murphy's sign
  • Spleen
  • Kidneys
    • Bimanual technique
    • hands in loin and just above anterior superior iliac spine
  • Abdominal aortic aneurysm
  • Examine hernial orifices

Percussion

  • Kinder way to elicit rebound tenderness
  • Resonance to dull
  • Upper and lower borders of liver
  • Shifting dullness
  • Fluid thrill

Auscultation

  • Bowel sounds x3
  • Bruits
    • aortic
    • iliac
    • renal
  • Succussion splash

For completeness

 

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