Approach
- Exposure of the abdomen
- Degree of exposure depends on the case
- Position the patient flat on the bed, keep groin area covered until later
- Start by looking for peripheral stimata of gastrointestinal disease
- Hands
- Signs of chronic liver disease and IBD
- Koilonychia (spoon shaped nails in IDA)
- Pallor of palmar creases in anaemia
- Check for liver flap (late sign of hepatic encepalopathy)
- Eyes
- Anaemia
- Jaundice
- Mouth
- Hepatic fetor
- Pallor of mucous membranes
- Neck
- Palpate for supraclavicular lymphadenopathy - Virchow's node (Troisier's sign) foun din supraclavicular fossa between the sternal and clavicular heads of sternocleidomastoid muscle
- Trunk
- Inspect rest of arms and upper chest wall for spider naevi
- Briefly inspect the back
- Abdomen
- Expose down to the pubic symphysis
- Inspect: stand back from the couch
- Distension
- Scars
- Visible pulsation
- Ask patient to take a deep breath in and hold - seeing transmitted pulsation of AAA
- Ask patient to cough / lift head off bed to demonstrate herniae
- Palpate: kneel down to patient's right side
- Ask if they have any pain anywher before beginning palpation
- Look at patient's face while attempting to elicit tendeness
- Begin farthest away and palpate 9 quadrants
- Check for pulsation in the epigastric region
- Continue with deep palpation in the 9 quadrants
- Palpate the liver
- Palpate the spleen
- Ballot the kidneys
- Percuss
- Spleen and liver
- Percuss for ascities
- Ascultate
- Liver bruit
- LIF for bowel sounds
- AAA, iliac vessels for bruit
Continue
- Expose external genitalia
- Examine scrotum
- Examine inguinal canal for herniae
- Palpate the femoral pulses and check for femoral herniae
Completion
- Cover patient
- Review observations - Temp, BP, pulse, RR
- Examine lower limbs - peripheral oedema
- Examine external genitalia and groin (if not already done)
- PR / Digital rectal examintion
- Dipstick the urine