Abdominal Examination Worksheet

Key Principles

• Ensure correct hygiene (e.g., handwashing)

• Introduce yourself, maintain eye contact, and be pleasant

• Perform examination routine fluently

• Explain examination to patient, give clear instructions, and obtain consent where appropriate

• Couch should be flat, patient sits for observation, then lies down

• Expose abdomen

• Pillow under head and knees for muscle relaxation

• Ask patient if they need to empty bladder before starting

• For female patients, inquire about menstruation or pregnancy

• Equipment Needed: Stethoscope, urinalysis sticks, and pots

Initial Observations

Patient Seated on Edge of Couch

• Hands: Look for leuconychia, clubbing, koilonychia, palmar erythema, Dupuytren’s contracture, flapping tremor
• Face: Observe for cachexia, pallor, yellowing, rhinophyma, parotid swelling, xanthelasma
• Eyes: Ask patient to pull lower eyelid, check for conjunctival pallor, yellowing of sclerae
• Mouth: Use pen torch for inspection, look for ulceration, glossitis, angular stomatitis, gingivitis, Candida, lichen planus, leukoplakia

Supraclavicular Nodes

• Palpate both sides, especially left side for Virchow’s node

Abdominal Observation

• Skin: Check for scratch marks, bruises, spider naevi, gynaecomastia, yellowing
• Abdomen: Look for scars, veins, striae, lipoma, herniae, rigidity, masses, distension

Auscultation

• Auscultation of abdomen before palpation
• Bowel Sounds/Borborygmi: Focus on right lower quadrant, listen for 2 minutes per area
• Bruits: Use bell over epigastrium and upper quadrants to detect abdominal aorta, hepatic and splenic bruits

Percussion

• General Percussion: Whole abdomen in clockwise spiral from umbilicus
• Liver: Percuss from right iliac fossa upward and from 5th intercostal space downward to determine liver borders
• Spleen: Percuss diagonally from below and right of umbilicus towards left costal margin
  • Traube’s space: normally tympanic, dullness may indicate issues like splenomegaly
• Ascites: Test for fluid thrill and shifting dullness

Palpation

Light Palpation

• Conduct light palpation clockwise from the umbilicus
• Observe patient comfort, recognize normal structures (e.g., caecum, liver edge)

Deep Palpation

• Explain procedures clearly, ensure patient comfort
• Liver: Use technique matching patient’s breathing
• Spleen: Similar technique but gentler to avoid rupture
• Kidneys: Bimanual palpation, test for inflammation (kidney punch)
• Gall Bladder: Murphy’s sign, pain during inspiration indicates issue
• Abdominal Aorta: Inspect for bruits, then palpate
• Inguinal Lymph Nodes: Assess both sides, ensure safeguarding

Appendicitis Findings

• McBurney’s Point: Awareness of anatomical location
• Rebound Tenderness: Demonstrate for pain
• Signs:
  • Rovsing's sign, Psoas sign, Obturator sign
• Common symptoms include nausea, vomiting, fever, tachycardia, constipation (sometimes diarrhea), urinary frequency

Other Tests

• Urinalysis: Note that urinalysis will not be part of the Clinical Skills assessment

This worksheet is a comprehensive guide for conducting abdominal examinations, including key principles, initial observations, and detailed techniques for auscultation, percussion, and palpation. It also highlights the necessary steps and signs to look for during these procedures.