Abdominal Physical Exam

  • WIPE, blah blah 🙂
  • “Take vital signs”
  • Position: flat, arms on the side, pillow below the head
  • Proper exposure: from xiphoid to mid-thigh
  • General inspection of the pt and surrounding

 

  • Peripheral signs:
    • Nails:
      • Capillary refill
      • Clubbing
      • Cyanosis
      • Koilonychia
      • Leukonychia
    • Hands:
      • Palmar erythema
      • Pulse
      • Tremor
    • Arms:
      • Purpura
      • BP
    • Eyes:
      • Pallor
      • Jaundice
    • Mouth:
      • Central cyanosis
      • Dry mucous membrane
      • Dental hygiene
      • Ulcers
    • Neck:
      • JVP
      • Lymphadenopathy
  • Abdomen inspection: (stand at the end of the bed)
    • Symmetry and contour
    • Abdominal distention + flank fullness
    • Scars, skin changes\discoloration, rashes, straie
    • Obvious masses or swelling
    • Dilated veins\caput medusa
    • Visible pulsations
    • Umbilicus (inverted\everted?)
    • Hernias (ask pt to cough)
  • Palpation + percussion: (ask pt if they have any pain? Be at the level of the pt’s abdomen)
    • Superficial and deep: “abdomen soft and lax, no tenderness, no masses”
    • Liver span (6-12 cm)
    • Gallbladder (Murphy’s sign)
    • Spleen (turn the pt towards you -normally non-palpable!)
    • Kidneys
    • Bladder
    • Ascites: shifting dullness + fluid thrill
  • Auscultation:
    • Bowel sounds
    • Bruits: Aortic, renal, femoral
  • To complete:
    • Digital rectal exam (PR)
    • Genital exam
    • Fecal occult blood test

 


Stigmata of chronic liver disease:

  • Clubbing
  • Leukonychia
  • Palmar erythema
  • Dupuytren’s contracture
  • Scratch marks
  • Astrexis
  • Parotid enlargement
  • Gynecomastia
  • Caput medusa
  • Ascites
  • Splenomegaly
  • Testicular atrophy
  • LL edema

 

How to differentiate between a renal mass vs a splenic mass on physical exam?

Spleen Kidney
Can’t get above it Can get above it
Has a notch Round, no notch
Moves w\ resp (towards Rt iliac fossa) Ballotable
Dull on percussion Resonant on percussion

 


Download the PDF version: here

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