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Abdominal Examination (2. Palpation (Ask if pt is in any pain
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Abdominal Examination
2. Palpation
- Ask if pt is in any pain
- Start palpation away from pain site
- Watch pt's face for signs of distress when palpating
1) Light Palpation
- Palpate all 9 areas
- Look for:
- Tenderness
- Guarding
- Masses
- Rebound tenderness (peritonitis pain)
2) Deep Palpation
- can use both hands together
- look for same features
3) Liver Palpation
- Start in RIF
- Palpate up towards right costal
margin with each inspiration
- Check for Murphy's sign
4) Spleen Palpation
- Start at RIF
- Palpate towards LUQ with each inspiration
5) Aorta Palpation
- Press midline with both hands above umblicus
- Normal aorta = pulsatile
- AAA = expansile
6) Balloting Kidneys
- Palpate bi-manually
- one hand on abdomen
- other hand underneath
- flick upwards to push kidney up
- normally palpable only on thin pts
1. Inspection
General
- Well-being
- Weight
- Pain/discomfort
- Position
- Jaundice
Hands
- Duputytren's Contracture
- Finger clubbing
- Palmar erythema
- Xanthoma
- Leuconchyia/koilonychia
- Asterixis (outstretch pt's arms)
Head/Neck
Eyes
- Sclerae (jaundice)
- Pallor conjunctiva
Mouth
- Ulcerations
- Candidiasis
- Angular stomatitis
- Dehydration
Neck
- Examine cervical lymph nodes
- Virchow's node (left supraclavicular region)
Chest
- Spider naevi
- Gynaecomastia (men)
Abdomen
- Symmetry
- Distension
- Striae
- Hernia
- Scars
- Caput medusa
- Cullen's sign
- Grey- Turner's sign
3. Percussion
- Percuss all 9 areas
Liver
Upper edge
- Start in RIF & percuss upwards to right costal margin
Lower edge
- Start in right 2nd ICS & percuss downwards
Shifting dullness - Ascites
- Percuss from midline to flank
(resonant --> dull)
- Turn pt on side and re-percuss
(fluid moves down with gravity,
resonant in flank)
4. Auscultation
- Bowel sounds
(diaphragm, place right of umbilicus, listen for 60 sec/until heard)
- Renal bruits
(use bell)
- Aortic bruits
(use bell, place over epigastrium)
5. Closure
- Check legs for oedema
- Conclude by stating to perform
- PR
- Urine dipstick/ pregnancy test
- External genitalia exam