What method of assessment is used to detect areas of tenderness of the abdomen?
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Examination of the Gastrointestinal System – detailedGastrointestinal examination and questions for doctors, medical student exams, finals, OSCEs and MRCP PACES Introduction (WIIPPPE)
General Inspection
Hands
Dupytren’s contracture Wrist
Video illustrating asterixis (flapping tremor) Arms
Face
Neck and Chest
Video on how to examine the lymph nodes
Abdominal examination video Inspection of the Abdomen
Palpation
Palpating for the Liver and GallbladderLiver
Video on how to palpate and percuss the liver Gallbladder
Abdominal anatomy. (A) Liver (B) Gallbladder (C) Ascending colon (D) Spleen (E) Stomach (F) Transverse colon
Video on Murphy’s sign Palpating for the Spleen The normal adult spleen lies immediately under the diaphragm in the left upper quadrant of the abdomen. It is not normally palpable, and can only be felt once it has increased in size threefold.
Palpating for the Kidneys The kidneys lie retroperitoneally in the paravertebral gutter of the abdominal cavity.
Abdominal anatomy. Transverse section at L1 level: (A) Liver (B) Gallbladder (C) Video on how to ballot the kidneys Palpating for the Aorta The aortic pulse is palpable in thin individuals, but is usually impalpable in muscular or obese patients. Palpation of the aorta is primarily to detect an abdominal aortic aneurysm (AAA) which may be asymptomatic but rupture of which can have a very high mortality.
The examiner uses both hands, parallel to the costal margins (certainly always above the umbilicus), to palpate for the aorta PercussionRoutine examination of the abdomen should include percussion. The whole abdomen should be percussed to demonstrate the presence of bowel gas (resonant) and solid or fluid-filled structures (dull). Percussion can also be used to map out a tender area identified during palpation. To gain maximum information from percussion, a good technique is important.
Video demonstrating percussion technique
Examining for AscitesNow try to ascertain whether the patient has ascites (free fluid in the abdominal cavity). Bear in mind that in most cases, ascites is associated with abdominal distension which you may already have detected on inspection.
Video demonstrating how to examine for shifting dullness (sign of ascites) Succussion SplashLastly, if you suspect gastric outflow obstruction you can try holding the patient at the hips and shaking the abdomen from side to side.
AuscultationAuscultation for Bowel Sounds
Auscultation for Bruits A bruit is an abnormal blowing or swishing sound resulting from blood flowing through a narrow or partially occluded artery.
Hernias
External Genitalia and Digital Rectal Exam
Completing the examination
Questions about the abdominal examination
Click here for medical student OSCE and PACES questions about Abdominal ExaminationCommon Abdominal Examination exam questions for medical students, finals, OSCEs and MRCP PACESWhat is the assessment technique for the abdomen?Assessing your patient's abdomen can provide critical information about his internal organs. Always follow this sequence: inspection, auscultation, percussion, and palpation. Changing the order of these assessment techniques could alter the frequency of bowel sounds and make your findings less accurate.
Which type of percussion is best for assessing tenderness?Direct percussion
This technique reveals tenderness; it's commonly used to assess an adult's sinuses. Using one or two fingers, tap directly on the body part. Ask the patient to tell you which areas are painful, and watch his face for signs of discomfort.
What is the correct way of performing an abdominal examination?With abdominal assessment, you inspect first, then auscultate, percuss, and palpate. This order is different from the rest of the body systems, for which you inspect, then percuss, palpate, and auscultate.
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