Abdominal Examination
Siu Him Chan
PGY-3
Internal Medicine
UBC
February 18, 2013
Outline
Approach to the abdominal examination
The exam itself
Hands-on session
Scenarios
Questions/ Feedback
General Introduction
Your name
The patients’ name, preferred way to be
address
Describe what you are going to do
Ask patient if he/she is comfortable to begin
Wash hands
Lighting, draping, positioning (lay patient flat)
– Be mindful of patient modesty for the abdo exam!
Approach to the Neuro Exam
Vitals
Inspection
Auscultation
Percussion
Palpation
Add-ons
Vitals
BP
HR
RR
SaO2
Temp
Inspection
General: in pain? Distress?
Position: still peritonitis
Color
– Jaundice/ pallor/ cyanosis
– Bruising (eg. Gray-Turner’s Sign, Cullen’s Sign etc.)
– Spider angiomas
Hands and Nails
– Palmar erythema (liver disease)
– Dupuytren’s contracture (liver disease, alcoholism)
Inspection
– Clubbing (liver disease)
– Hypertropic osteoarthropathy (HOA): triad of
clubbing, arthralgias, and ossifying periostitis (liver
disease)
– Terry’s nails: fingernails appear white with no lunula
(liver disease)
HEENT
– Parotid swelling (alcoholism)
– Fetor hepaticus (portal hypertension)
– Jaundice
Inspection
– Temporal wasting (alcoholism)
– ?Encephalopathic
Orientation
Chest
– Spider angioma (>3 males, >5 females = abnormal)
– Loss of axillary hair (liver disease)
– Gynecomastia (liver disease)
Abdomen
– Contour: normal vs. scaphoid vs. protuberant
Inspection
– Protuberant abdomen
Fat
Fluid
Feces
Flatus
Fetus
Fatal growth (cancer)
– Lower half think: pregnancy, fibroid, ovarian tumor
– ?Bulging flanks (ascites)
Genitourinary
– Testicular atrophy (liver disease)
Inspection
Extremities
– Bruising (consequence of lower platelets from
liver disease)
– Track marks (IV drug usage)
– Swelling (liver disease)
Auscultation
Abdomen
– Listen to all 4 quadrants (?)
– Comment on normal/ absent/ increased
Absent: ileus
Increased: diarrhea
– Liver: ?bruit
– Succussion splash: listen for splash while moving
patient at the hips ?obstruction
Percussion
Abdomen in general
– Percuss the painful area LAST
– If pain on percussion = percussion tenderness
?peritonitis acute abdomen general surgery
– Percuss all 4 quadrant
Liver
– Start at umbilicus, percuss upwards in mid-
clavicular line and mid-sternal line
– Normal span = MSL 4-8 cm, MCL 9-11 cm
Percussion
Spleen
– Castell’s Sign
Patient takes deep breaths in and out
Percuss at the 10th intercostal space in the left anterior
axillary line
(+) when dull on inspiration
Sensitivity and Specificity in the 80s
– A More specific test is the Nixon’s Test
– Traube’s space (6th space, L costal margin, MAL)
Ascites
– Shifting dullness
– Fluid wave
Palpation
General:
– Light and deep
– Palpate tender area(s) last
– Guarding
Liver:
– 2 handed method
– The Hook
– Scratch Test
Palpation
Spleen
– Start at RIGHT lower quadrant, angles towards
anterior axillary line
Kidney
– R kidney: stand on R side of patient
– L kidney: stand on L side
– Try to catch kidneys between 2 hands (1 below
costal margin, the hand underneath trys to lift up the
kidney), but normally not palpable
Add-ons
Appendicitis
– McBurney’s Point
– Psoas Sign
– Obturator Sign
Cholecystitis
– Murphy’s Sign: “catch” in breath
Digital Rectal Exam (DRE)
– Need to mention it
– Inspect for fistula (inflammatory bowel disease), tears/
hemorrhoids (lower GI bleed)
– Feel for protate if male
– Check for blood on gloved hand +/- fecal occult blood test
Scenarios
Abdominal pain
Nausea/ vomiting
Constipation/ diarrhea
Hematemesis/ hematochezia/ Melena
Thank you!
