Overview

This lecture provides a step-by-step guide to performing an abdominal examination, including inspection, palpation, percussion, and auscultation, along with relevant clinical signs.

Preparation and Initial Steps

• Wash hands, introduce yourself, confirm patient identity, explain the examination, obtain consent, and check for pain.
• Position the patient at a 45-degree angle and provide appropriate exposure from xiphisternum to symphysis pubis.

Inspection

• Inspect the abdomen for scars, distension, jaundice, cachexia, hernias, and medical equipment.
• Inspect hands for pallor (anemia), palmar erythema (liver disease), and Dupuytren’s contracture (alcohol use).
• Check nails for koilonychia (iron deficiency) and leukonychia (low albumin/liver disease).
• Assess for finger clubbing (ulcerative colitis, Crohn's, liver cirrhosis).
• Look for asterixis (flapping tremor, hepatic encephalopathy).
• Compare hand temperatures and assess pulse.
• Inspect arms for bruising (coagulopathies), excoriations (cholestasis), needle marks, and spider nevi (>3 is pathological).
• Inspect axilla for acanthosis nigricans (diabetes/cancer) and hair loss (malnutrition).
• Inspect eyes for conjunctival pallor (anemia), jaundice, corneal arcus, xanthelasma (hypercholesterolemia), and Kayser-Fleischer rings (Wilson’s disease).
• Inspect mouth for angular stomatitis and glossitis (iron, B12, folate deficiency).

Lymph Node and Chest Inspection

• Palpate supraclavicular fossa for Virchow’s node (abdominal malignancy).
• Inspect chest for spider nevi, gynecomastia, and hair loss.

Auscultation

• Lie patient flat, arms at sides; listen for bowel sounds for up to two minutes.
• Auscultate over renal arteries for bruits; check aortic region as needed.

Palpation

• Ask about pain before palpating; examine tender areas last.
• Palpate all nine abdominal regions lightly, then deeply, watching for pain.
• Palpate liver (start at right iliac fossa), spleen (start at right iliac fossa), and kidneys (bimanual ballotment).
• Palpate abdominal aorta for pulsatile mass (suspect AAA).
• Palpate gallbladder/bladder if indicated (usually not palpable in healthy patients).

Percussion

• Percuss liver and spleen borders from right and left iliac fossae towards costal margins.
• Assess for shifting dullness to detect ascites.

Additional Assessments

• Check for pedal edema (suggests low albumin).
• Suggest further investigations: assess hernial orifices, perform digital rectal exam, examine external genitalia, and consider abdominal imaging.

Key Terms & Definitions

• Asterixis — a flapping tremor seen in hepatic encephalopathy.
• Koilonychia — spoon-shaped nails, sign of iron deficiency anemia.
• Leukonychia — whitening of nails, indicates low albumin or liver disease.
• Spider nevi — small, dilated blood vessels, often due to liver disease.
• Kayser-Fleischer rings — brownish rings around the iris, associated with Wilson’s disease.
• Virchow’s node — enlarged left supraclavicular lymph node, suggests abdominal malignancy.
• Shifting dullness — change in percussion note from resonant to dull, seen in ascites.

Action Items / Next Steps

• Summarize and document findings after examination.
• Wash hands after the procedure.
• Suggest further investigations as applicable (hernial orifices, DRE, genitalia, imaging).

---

Certainly! Here's a checklist for performing an abdominal examination based on your notes:

---

Abdominal Examination Checklist

Preparation

• [ ] Wash hands
• [ ] Introduce yourself to the patient
• [ ] Confirm patient identity (name, date of birth)
• [ ] Explain the examination and obtain consent
• [ ] Check if the patient is in pain
• [ ] Position patient at 45-degree angle
• [ ] Expose abdomen from xiphisternum to symphysis pubis with privacy

Inspection

• [ ] Inspect abdomen for scars, distension, jaundice, cachexia, hernias, medical equipment (stoma bags, drains, tubes)
• [ ] Inspect hands:
  • [ ] Pallor (anemia)
  • [ ] Palmar erythema (liver disease)
  • [ ] Dupuytren’s contracture (alcohol use)
• [ ] Inspect nails:
  • [ ] Koilonychia (iron deficiency)
  • [ ] Leukonychia (low albumin/liver disease)
• [ ] Assess finger clubbing (ulcerative colitis, Crohn’s, liver cirrhosis)
• [ ] Check for asterixis (flapping tremor)
• [ ] Compare hand temperature and assess radial pulse
• [ ] Inspect arms for bruising, excoriations, needle marks, spider nevi (>3 pathological)
• [ ] Inspect axilla for acanthosis nigricans and hair loss
• [ ] Inspect eyes for:
  • [ ] Conjunctival pallor
  • [ ] Jaundice
  • [ ] Corneal arcus
  • [ ] Xanthelasma
  • [ ] Kayser-Fleischer rings
• [ ] Inspect mouth for angular stomatitis and glossitis

Lymph Node and Chest Inspection

• [ ] Palpate left supraclavicular fossa for Virchow’s node
• [ ] Inspect chest for spider nevi, gynecomastia, hair loss

Auscultation

• [ ] Lie patient flat, arms by side, legs uncrossed
• [ ] Listen for bowel sounds (up to 2 minutes)
• [ ] Auscultate renal arteries for bruits
• [ ] Auscultate aortic area if indicated

Palpation

• [ ] Ask about pain before palpation; examine painful areas last
• [ ] Lightly palpate all nine abdominal regions
• [ ] Deeply palpate all nine abdominal regions
• [ ] Palpate liver (right iliac fossa upwards)
• [ ] Palpate spleen (right iliac fossa towards left costal margin)
• [ ] Bimanual palpation of kidneys (ballotment)
• [ ] Palpate abdominal aorta for pulsatile mass
• [ ] Palpate gallbladder and bladder if indicated

Percussion

• [ ] Percuss liver borders (right iliac fossa to costal margin)
• [ ] Percuss spleen borders (right iliac fossa to left costal margin)
• [ ] Assess shifting dullness for ascites

Additional Assessments

• [ ] Check for pedal edema
• [ ] Suggest further investigations if needed:
  • [ ] Hernial orifices assessment
  • [ ] Digital rectal examination (DRE)
  • [ ] External genitalia examination
  • [ ] Abdominal imaging

Completion

• [ ] Explain examination is finished
• [ ] Thank the patient
• [ ] Wash hands
• [ ] Summarize and document findings

---

Let me know if you'd like this checklist formatted differently or expanded!