Clinical
Clinical
Examination Skills
The Abdomen
Chris Mulryan
Aim & Objectives
To provide participants with the knowledge needed to
undertake a focused assessment of the abdomen
• Describe the common presentations that suggest a
possible abdominal pathology
• Outline the steps of the abdominal examination
• Explain both the normal and abnormal findings
Principal Abdominal
Presentations
• Pain • Water brash
– Defuse • Flatulence
– Localised • Distension
– Referred • Altered Bowel Habit
– Constant / Colicky • Constipation
• Indigestion / Heart Burn • Diarrhoea
• Dysphasia • Blood PR (heamatochezia)
• Globus • Haematemesis
• Odnophagia • Jaundice
• Nausea
• Vomiting
• Anorexia
The Four Quadrants of the
Abdomen
Right Left
Upper Upper
Right Left
Lower Lower
The Nine Anatomical
Regions of the Abdomen
RH E LH
RF U LF
RIF H LIF
The Anatomical Regions
RH = Right Hypochondrium
RF = Right Flank
RIF = Right Illiac fossa
E = Epigastrium
U= Umbilical
H= Hypogastrium
RH = Right Hypochondrium
RF = Right Flank
RIF = Right Illiac fossa
Surface Anatomy
Localisation of Visceral Pain
• Lower Oesophagus
• Stomach
• Liver
• Duodenum
• Small Intestine
• Appendix >> RIF
• Ascending Colon
• Most Transverse colon
• Descending Colon
• Sigmoid Colon
Referral Of Pain
End Of Bed Assessment
Inspect the Hands
Abdominal Stigmata
• Clubbing
• Palmer Erythema
• Leukonychia
• Koilonychia
• Dupuytren's contracture
• Capillary Refil
• Asterxis (Liver Flap)
Arms
• Pulse
• Blood Pressure
• Shock
– Low Volume Status
• Skin Turgor
Face, Eyes & Mouth
• Colour of skin; pallor,
Jaundice, Spider Nevi
• Eyes; anaemia,
jaundice
• Mouth; Ulcers,
Glossitis, angular
stomatitis,
Parotid Swelling
Neck Lymphatics
Inspect The Chest
Inspect The Abdomen
Stand the Patient To Assess for Hernias
Inspect The Abdomen
Inspect The Abdomen
Normal Direction of Blood
Flow
Direction of Blood Flow
Portal Hypertension IVC Obstruction
Inspect The Abdomen
Stand the Patient To Assess for Hernias
Causes of Abdominal
Distension
The Five ‘F’s
Fat
Flatus
Faeces
Fluid
Fetus
Palpate The Abdomen
• All 9 regions
• Ask about pain & do painful areas last
• Kneel down
• Light Palpation
• Deep Palpation
• Aorta
• Kidneys
• Spleen & Liver some percussion needed
Possible Findings
• Ask patient to report pain
• Voluntary Guarding
• Involuntary Guarding
• Tenderness
• Rebound Tenderness
• Masses
– Solid
– Aortic
Liver Enlargement
Spleen Palpation
Percussion Of The Abdomen
• Liver Span
• Spleen
• Shifting Dullness
• Fluid Thrill
• Chosto vertebral Tenderness
Ascultate The Abdomen
• Bowel Sounds • Bruits
– Borborygma – Aorta
– Liver
– Absence = Ileus – Spleen
– Tinkling = Obstruction – Renal
• Succussion Splash
Inguinal Area & Genitals
Inguinal Area & Genitals
Inguinal Area & Genitals
Rectal
Rectal
Rectal
Rectal
Final Points
• Digital Rectal Examination
• Dip urine
• U&E
• FBC
• Clotting
• LFT
• Glucose
• Amylase
• FOB
• Paracetamol & Salicylates
• ABG
• AXR
• Abdominal Ultrasound
