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1 Abdominal Examination Oct 2011

The document provides instructions for conducting a focused abdominal examination. It outlines 11 steps: 1) introducing yourself and explaining the exam; 2) preparing the patient; 3) taking vital signs; 4) inspection; 5) auscultation; 6) percussion; 7) palpation; 8) checking for hepatomegaly; 9) checking for splenomegaly; 10) checking for ascites; and 11) checking for special signs. It emphasizes maintaining a differential diagnosis, only communicating findings to the examiner, and being prepared to answer an ending question about diagnosis or management.

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130 views21 pages

1 Abdominal Examination Oct 2011

The document provides instructions for conducting a focused abdominal examination. It outlines 11 steps: 1) introducing yourself and explaining the exam; 2) preparing the patient; 3) taking vital signs; 4) inspection; 5) auscultation; 6) percussion; 7) palpation; 8) checking for hepatomegaly; 9) checking for splenomegaly; 10) checking for ascites; and 11) checking for special signs. It emphasizes maintaining a differential diagnosis, only communicating findings to the examiner, and being prepared to answer an ending question about diagnosis or management.

Uploaded by

suaqazi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Abdominal

Examination
By Sam Gharbi

UBC Internal Medicine R3


Study Materials
 Old Exam Questions

 Physical Exam books:


 Schwartz - Textbook of Physical Diagnosis
 Bates – Guide to Physical Examination

* Recommend practicing scenarios with a friend.


Scenario
 35 year old female presents with 3 day history of
nausea, vomiting, and severe left lower quadrant
abdominal pain.

 Conduct a focused physical examination.

 Tip: Have a differential diagnosis in mind prior to


starting the station.
Step 1: Intro
 Prepare stickers (2) and hand them to examiner

 Wash hands with hand sanitizer

 Introduce yourself to the patient

 Explain to them what you will be doing


Step 2: Prepare the patient
 Appropriate lighting
 Patient lying flat with arms at the side
 Appropriate draping
 Stand on patients right side
 Relax abdominal wall by flexing knees
Step 3

Vital Signs!
Hint
 As you do exam, only mention to examiner your
findings (both positive and negative)

 Do NOT narrate through your actions!


Step 4: Inspection
 Distended?
 Bulging flanks?
 Scars?
 Dilated veins?
 Caput medusae
 Striae (stretch marks)
 Recent: pink
 Cushing’s: purple
 Silver: obese / old
Step 5: Auscultation
 Listen to each abdominal quadrant with
diaphragm of stethoscope
 Note frequency of sound
 Normal is clicks and gurgles
 Increased: diarrhea or early intestinal
obstruction
 Decreased then absent: adynamic illeus
and peritonitis
Step 6: Percussion
 Percuss all 4 quadrants for sound and pain:
 Normal: Tympany
 Abnormal: Dull (Due to fluid)
 A proturberant abdomen that is tympanic
throughout suggests intestinal obstruction
Step 7: Palpation
 Light Palpation
 Ask where it hurts and palpate this quadrant last
 Keep hand horizontal and flex fingers gently
 Palpate all 4 quadrants
 Lift hand completely off between quadrants

 Deep palpation
 Use same technique as above but push harder.

**DO not forget to palpate for rebound tenderness


Step 8: Hepatomegaly
 Start with gentle pressure in the right lower quadrant
(midclavicular line)
 Ask the patient to breathe in gently and slowly to
bring the liver edge down to the examiners
fingertips
 At each exhalation, move the fingers up roughly 2
cm.
 If the edge is not felt, no further examination is
suggested
 If the edge is felt, mark the location where the lower
edge was felt and then proceed to percussion
Hepatomegaly (…)
 Begin percussion at the level of the third rib
space, at the midclavicular line

 Move down one rib space at a time until the


tone of your percussion changes. This is due to
the interposition of the dome of the liver behind
the lung
Step 9: Splenomegaly
 Castell’s sign:

 With the patient in full inspiration and then full


expiration, percuss Traube’s space.

 If the note does not change (ie. remains tympanic)


then it suggests the presence of a normal spleen,
and the sign is considered negative.

 If the note changes from resonant on full expiration


to dull on full inspiration, the sign is regarded as
positive, and suggests splenomegaly.
Step 10: Ascites
 Very unlikely that you will be required to test for
ascites.

 The most useful findings for making the diagnosis


of ascites are a:
 positive fluid wave
 shifting dullness
 peripheral edema.
Step 11: Special Signs
 McBurney’s point tenderness

 Murphy’s sign
 Place Fingers under coastal margin on right side at
mid-clavicular line and have the patient to a deep
breath while you push. Arrest of deep inspiration will
cause pain.
Important
 At the end of the examination, do not forget to
mention that you would also do a pelvic and
rectal examination (if appropriate)

 Note: not mentioning this, or other crucial details,


may result in failing the station.
End of station question
 With one minute left in the station, the examiner will
ask you a question, for example:

What is this patient’s diagnosis?

Or

What further management would you do?


Other hints & tips
 Be confident!

 Be empathic!

 Dress professionally.

 Points are given subjectively based on the


examiners assessment on your interaction with
the patient.
Good
Luck!
Thank you for attending the
AIMD BC Fall 2010,
Education Sessions

If you have any question or


suggestion regarding the
Association, feel free to contact us
at [email protected]

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