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
Chest inspection – patient flat on back
W.I.P.E.E
- Lying down - Closer inspection for everything earlier
- Exposure = waist up, ideally no bra - Spider naevi - >5 = chronic liver disease
- Gynaecomastia – liver cirrhosis, digoxin,
General inspection: spironolactone
- Body habitus
- Scars? Laparotomy, appendectomy, cholecystectomy Palpation
- Jaundiced?
- Abdominal distension? Fat, Fluid, Flatus, Foetus, Faeces - Check again if any pain
- Masses? - 1st palpate soft, snake 9 regions, then 2 nd harder
- Stoma? o Check for guarding, masses, rebound tenderness
- Bruising? = peritonitis
- Hernias? - 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 underneath
- Clubbing – IBS, cirrhosis, coeliac disease with the other
- Koilonychia – spoon nails = chronic iron deficient - Palpate aorta – pulsatile = suggests abdominal aortic
aneurysm
- Leukonychia – white nails – liver failure
- 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 – hold hands out 30secs, asterixis - Test for shifting dullness if suspected ascites
o Across from bellybutton, then patient roll to
= hepatic encephalopathy (associated with severe liver
disease), uraemia other side, wait 30secs, test again
o Do both sides
- Scratch marks – cholestasis (bile salts under skin)
- Needle tracks – risk for viral hepatitis
- Bruising – coagulopathy/liver disease Auscultation
- Petechiae, red/purple spots – low platelets =
splenomegaly - Normal = gurgling
- Examine pulse – rate, rhythm, character - Tinkling = bowel obstruction
- Absent = ileus/peritonitis
Neck - Test for aortic bruit
- Check lymph nodes - incl. supraclavicular
o Malignancy/infection
Summarise
“no peripheral stigmata of gastrointestinal disease”
Face/mouth/eyes
“abdomen was soft and non-tender, with no masses or
- Xanthelasma – yellow deposits around eye organomegaly”
- Conjunctival pallor – anaemia
- Yellow sclera – jaundice, raised bilirubin “on auscultation, I heard normal bowel sounds”
- Blue/white ring around iris – corneal arcus
- Ulcers – Crohn’s or coeliac disease To complete the examination:
- Angular stomatitis – inflammation in corners of mouth
= iron/b12 deficiency - Examine hernial orifices
- Perform a digital rectal exam
- Glossitis/tongue swelling = iron/b12/folate deficiency - Examine the external genitalia
- Oral candidiasis – white stuff on tongue = iron or
immunodeficiency If appropriate!
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller PassMedSchool. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for £3.49. You're not tied to anything after your purchase.
