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Abdominal Skills And Examination
Right side of patient
‘I’m now going to examine your abdomen. Are you ok lying flat? We can use this sheet/your gown/bra to cover your chest.’
Exposure: Nipples to knees (in practice sheet covers external genitalia.)
Position: Lower bed flat, with patient resting on one pillow. Arms by sides.
Distension, scars (ask patient to identify), drains and stomas (follow the drain and see what is draining. Identify type of stoma), masses, vessels, striae, hernias.
‘Can you raise your head off the pillow for me. Can you breathe in and out. Can you suck your tummy in and puff it out as best you can. And can you give a cough.’ ‘What is this scar from?’
Palpation & Percussion
Assess for a triple A by placing hands either side of umbilicus.
Feel for hernias in inguinal region and ask patient to cough.
‘I’m going to feel for a pulse in your groin and feel for any hernias.’
Squat by side of bed so patient’s abdomen is at eye level. ‘I’m going to feel your abdomen. Are you in any pain?’ Look at patient’s face and begin light palpation at point farthest from pain. Palpate in the four quadrants.
‘I’m going to press a little more firmly now.’
Palpating a mass: feel for size, shape, surface, consistency, mobility, pulsatile nature, movement with respiration.
Liver: begin in right iliac fossa, exert gentle pressure and ask patient to breathe in and out. With inspiration drift palm upwards towards liver.
Percuss Liver - map upper and lower borders of liver.
Map top from resonant lung field and then bottom of liver from right lower quadrant.
Normal: Around 5th IC midline to costal margin.
Spleen: begin in right iliac fossa below umbilicus. Ask patient to breathe in and out moving towards left costal margin.
Percuss Spleen - percuss from umbilicus to left costal margin. Unable to map top due to heart
Kidneys: Place left hand behind right loin Place right hand at costal margin. Push down with right hand balloting the kidney. Repeat for left kidney.
Ascites – Percuss centrally, from umbilicus, to flank on left side. Ask patient to roll towards you and percuss back if ascites present.
Listen for 15-20 seconds for bowel sounds
Listen for renal bruits – press down firmly few cm above umbilicus at lateral edge of rectus muscle.
Listen for femoral bruits over femoral pulse.
State to Examiners
‘I would also examine he external genitalia, dipstick the urine and perform a PR examination.’