Say "may I examine your abdomen"
Inspect at end of bed for pallor, jaundice, spider naevi.
Say "Could you hold out your hands straight out please,
and cock up
your wrists," and inspect for a flapping tremor of ammonia retention
Inspect nails for clubbing, leuconychia (low
albumin), koilonychia (anaemia), palmer erythema (liver disease). Say,
"could you turn your hands over" and feel for dupuytrens contracture
(below the little finger).
Face and neck
Look at eyes for anaemia, icterus, and xanthelasma.
Look in mouth for cyanosis, ulcers
Feel lymph nodes, especially left supraclavicular
(Virchov's node, classically gastric cancer).
Inspect for spider naevi (if present press on them - they
Gynaecomastia, paucity of body hair
Expose: ideally from nipple to knee, whilst covering
distension, pulsation, caput medusa (veins originating from umbilicus)
Get patient to take head off bed (hernias on abdomen
become prominent), and take a deep breath in and out.
Say "do you have any pain," and if so get them to point to
it. Say "I'm
going to touch your tummy, tell me if it is tender at any point."
essentially for tenderness. Keep eyes on the patients face (this is not
embarrassing although it may feel so initially, as they soon turn their
eyes away). Do this sequentially in all areas.
essentially for masses.
Start in right iliac fossa and travel towards right lower rib. Use
border of first finger. Push up slightly as you ask them to breath in.
Remember to keep looking at their face (for Murphy's sign).
from below and above liver to confirm size.
Start in right iliac fossa and travel towards left lower rib.
Ballot kidneys: hands on flank, with one hand on top, one
below the body. Press in with the lower hand and feel with the upper.
Repeat on other flank.
for an aortic
aneurysm. Use 2 hands either side of midline. Aneurysms are expansile
Shifting dullness (if the abdomen is distended, useless
Percuss from midline to left flank. If dullness in flank then leave
finger over dull area and ask patient to roll towards you then percuss
again at this spot, which should now be resonant for a positive test.
artery bruits, and bowel sounds
Palpate the ankles for oedema
"I would like to"
Examine the external genitalia
Perform a PR examination
Common OSCE stations
Polycystic kidney disease
Chronic liver disease
man is jaundiced. He has clubbing and palmer erythema. There is
gynaecomastia and spider naevi. There is no lymphadenopathy.
examination of his abdomen there is caput medusa. There is tense
swelling and the umbilicus is everted. There is shifting dullness,
suggesting ascites. The liver is palpable at 3cm below the right costal
margin, there is no other organomegaly.
My diagnosis would be chronic liver disease.
The Abdomen. Public doman Grays Anatomy (1918).