Abdominal examination

Summary

Follow a step-wise system: inspect, palpate, percuss and auscultate (in that order). To ensure that the abdominal examination is thorough and that nothing is overlooked, expose the patient from ‘nipples to knees’. In the clinical setting try tomaintain the patient's dignity. Get the patient to relax – remember if the patient is tense, it will be difficult to feel anything within the abdomen. Ask the patient to lie down on the bed with the arms by the sides. Once you have ensured that the patient is suitably relaxed commence the examination.

1. Inspection:

1. ▪ Look for any general abnormalities, such as cachexia, frank jaundice or pallor.

2. ▪ Look for any obvious abdominal swelling/distension (Fat, Faeces, Flatus, Fluid, Fetus).

3. ▪ Look for skin lesions (e.g. spider naevi (liver disease), pigmentation (Addison's), tortuous veins (IVC obstruction), caputmedusae (portal hypertension), striations (pregnancy/Cushing's).

4. ▪ Look for scars – do they correlate with the surgical history?

5. ▪ Check abdominal movements on breathing – does the patient appear to find this uncomfortable/painful? If so, this may be suggestive of peritonitis.

6. ▪ Check hands – clubbing, palmar erythema, leuconychia, Dupuytren's contracture, liver flap.

7. ▪ Check radial pulse – rate and rhythm.

8. ▪ Check face – dehydration, pallor of conjunctivae, jaundiced sclerae, telangiectasia, stomatitis.

9. ▪ Gross inspection for hernias – ask the patient to lift their head off the pillowor cough. Look for incisional/paraumbilical/inguinal hernia.

2. Palpation:

1. ▪ Begin by palpating the areas you might otherwise overlook. Feel for supraclavicular lymphadenopathy (Virchow's node).

2. ▪ Nowposition yourself at the same height as the patient's abdomen. Ask the patient if they currently have any abdominal pain.

3. […]