Abdominal Exam

Wash Hands Introduce Patients Name Explain Procedure Consent Expose Patient Position Supine, hands by side -eft ,idney .i ht ,idney Percuss Shiftin !ullness

Auscultate
#o9el Sounds 'min2 : minute* 8ortic #ruits .enal #ruits 'renal artery stenosis*

Inspect
Patients comfort at rest Surroundin s Nutritional State !istension S"in Colour Scars !eformities Stoma #a $ynaecomastia Caput %edusa Spider Nae&i '()*

Extras
P./P1 External $enitalia In uinal .e ions hernia/lymph nodes -eft supracla&icular node
Virchows node (abdo cancer Stomach in particular)

Close
6han" Patient Wash Hands

Hands
%etabolic +lap Spider Nae&i Clubbin ,oylincihia 'spoon shape* -euconychia '-i ht Colour* !upuytrens Contracture Pale Palmar Crease Palmar Erythema

Overall
7 # S %

Hernia Exam
Wash Hands Introduce Patients Name Explain Procedure Consent Expose Patient Position Standin

Pulses
.adial .ate/.hythm/Character 01P 'pt2 at 3) de rees*

Face
4anthalasma Con5uncti&al Pallor Scleral 0aundice Smooth, #eefy 6on ue 7lceration in mouth 8n ular Stomatitis

Inspect
S9ellin s Scars

Palpate
8s" patient to cou h +eel for cou h impulse 8s" patient to reduce 8ttempt reduction Co&er external rin and as" for cou h Chec" contralateral side If applicable: Scrotum examination Chaperone Palpate testis for size/shape etc Attempt to get abo e lump !ransilluminate

Palpate
8s" about pain location -i htly throu hout 'painful area last* !eep throu hout $uardin /.ebound 6enderness -i&er 'chan e position on expiration* Percuss chest to define upper mar in $all #ladder palpatin on inspiration causes uardin Spleen

Close

%ichael Smith ;<:<

Abdominal Exam
Would li"e to examine abdomen 6han" Patient Wash Hands

%ichael Smith ;<:<

Abdominal Exam
Questions Ho9 many spider nae&i need to be present to be clinically si nificant= "# What are the four types of causes in dyspha ia= $ral e%g% mouth ulcers &eurological e%g% bulbar pals' &euromuscular Phar'ngeal Pouch (echanical $esophageal Ca% What is the name for blood in &omit= )aematemesis What is a differential for Haematemesis= Peptic *lcer $esophageal aracies (allor'+,eiss tear -astric Cancer What are the causes of pancreatitis= Gallstones Alcohol these two ma.e up /01 !rauma Steroids (umps Autoimmune Scorpion 2ite )'pocalcaemia 34CP 5rugs What le&els of biliruben are needed for 5aundice to be clinically &isible= "#0 micromol/l What are the causes of abdominal distension= 6at 6latus 6aeces 6luid (ascities) 6oetus What does a metabolic flap indicate= )epatic 3ncephalopath' ,ernic.e+7orsa.off S'ndrome What does leuconychia indicate= )'poalbuminaemia What does "oylincihia indicate= 8ron 5eficienc' What is !upuytrens contracture and 9hat does it indicate= Palmar 6ascia thic.ening 9i er Cirrhosis &othing often idiopathic with genetic element What does a beefy smooth ton ue ' lossitis* indicate in this context= 8ron deficienc' /Pernicious anaemia What causes an ular stomatits= Anaemia What causes spider nae&i= 3le ated oestrogen due to li er damage What 9ould be the hi hest le&el 'rib* youd expect to palpate the upper li&er ed e= :th/#th What is %urphys si n and 9hat does it indicate= Place hand gentl' o er the gall bladder; as. pt to inspire% !est is positi e if the pt winces with pain on inspiration% Positi e in cholec'stitis% What is the difference bet9een uardin , rebound tenderness and a ri id abdomen= Guarding (uscle tensing due to pain on pressure Rebound Tenderness pain on remo al of pressure due to aggra ation of parietal peritoneum Ridged Abdomen 8ndicates peritonitis What 9ould you expect 9ith rebound tenderness o&er the .->= Appendicitis What 9ould you expect 9ith uardin in the -->= 5i erticulitis

%ichael Smith ;<:<