An example of a perfect abdominal examination for OSCE/ISCEs for medical students, or in clinical practice for junior doctors. Step-by-step guide covering an examination from hands-neck-face-chest, including signs, symptoms and their relevance in forming a clinical differential diagnosis. Covers fu...
Abdominal Examination -
-
Blue/white ring around iris = corneal arcus
Ulcers – Crohn’s or coeliac disease
- Angular stomatitis – inflammation in corners of
1. Wash hands mouth = iron/b12 deficiency
2. Introduce - Glossitis – tongue swelling = iron/b12/folate
3. Explain and gain consent deficiency
4. Correct position – 45degrees - Oral candidiasis – white stuff on tongue – iron or
5. Exposure – waist up, remove bra ideally immunodeficiency
General inspection: Chest inspection – patient flat on back
Patient-based: - Closer inspection for everything earlier
- Body habitus - Spider naevi - >5 = chronic liver disease
- Scars? Laparotomy, appendectomy, - Gynaecomastia = liver cirrhosis, digoxin,
cholecystectomy spironolactone
- Jaundiced?
- Abdominal distension? Fat, fluid, flatus, foetus,
Palpation
faeces
- Masses? - Check again if any pain
- Stoma? - 1st palpate soft, snake 9 regions, then 2 nd harder
- Bruising? o Check for guarding, masses, rebound
- Hernias? tenderness = peritonitis
- Visible peristalsis? - Palpate liver, patient breathe in+out, move up to
liver from hip, pushing hand in for in breath
- Palpate spleen in same way, but across from hip
Hands
- Ballot kidneys – push hand on top, flick
- Clubbing – IBS, cirrhosis, coeliac disease underneath with the other
- Koilonychia – spoon nails = chronic iron deficient - Palpate aorta – if moves hands, suggests
- Leukonychia – white nails – liver failure abdominal aortic aneurysm
- Palmar erythema = liver disease/pregnancy
- Dupuytren’s contracture = alcohol excess
Percussion
o Fingers permanently contracted
- Percuss up to liver from hip = hepatomegaly
- Percuss across up to spleen from hip
Wrists/arm
- Down bellybutton to pubis – urinary retention
- Liver flap; 30secs, asterixis = hepatic - Test for shifting dullness if suspected ascites
encephalopathy (ass. w/ severe liver disease), o Across from bellybutton, then patient
uraemia roll to other side, wait 30secs, test again
- Scratch marks = cholestasis o Do both sides
- Needle tracks = risk for viral hepatitis
- Petechiae, red/purple spots = low platelets =
Auscultation
splenomegaly
- Normal = gurgling
- Tinkling = bowel obstruction
Neck
- Absent = ileus/peritonitis
- Check lymph nodes; incl. supraclavicular - Test for aortic bruit
o Malignancy/infection
Summarise
Face/mouth/eyes
“no peripheral stigmata of gastrointestinal disease”
- Xanthelasma = yellow deposits around eye
“abdomen was soft and non-tender, with no masses or
- Conjunctival pallor = anaemia
organomegaly”
- Yellow sclera = jaundice, raised bilirubin
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