Full Abdominal Exam
Full Abdominal Exam
Please assess the student performing a complete abdominal exam, including the liver, spleen, and kidneys. The student should also assess for peritoneal irritation and ascites.
Student's Email:

GENERAL - Observe the student doing the following: (More info)

Washes hands
       
Introduces self and exam to patient
           
Appropriate draping of patient

Expose from the nipple line to the ASIS

               

INSPECTION - The student should comment on the following: (More info)

Patient's general appearance

Ex: writhing, still, cachectic, generally well/unwell etc.

               
Abdominal contour

Ex: masses, symmetry etc.

               
Scars

Ex: RLQ for appendectomy, midline for laparotomy etc.

               
Pulsations

Ex: Epigastric from abdominal aortic aneurysm

               
Ascites

Best observed from the foot of the bed (bulging flanks)

               
Skin changes or discolorations

Ex: Petechiae, ecchymoses, purpura, lesions, Cullen/Grey Turner's sign

               

INSPECTION FOR STIGMATA OF LIVER DISEASE - The student should comment on the following: (More info)

Nail changes

Ex: Clubbing, leukonychia or Terry's nails

               
Hand changes

Ex: Palmar erythema, Dupuytren's contracture, thenar wasting

               
Asterixis
               
Temporal muscle wasting
               
Scleral icterus
               
Fetor Hepaticus
               
Gynecomastia
               
Spider angiomas or telangiectasias
               
Caput Medusae
               
Testicular atrophy
               
Inspect for peripheral edema
               

AUSCULTATION - Observe the student performing the following manoeuvers: (More info)

Auscultates for bowel sounds in all 4 quadrants
               
Auscultates for aortic, renal, common iliac, femoral and hepatic bruits
               

PERCUSSION - Observe the student performing the following manoeuvers: (More info)

Percusses in all 4 quadrants

Comments on quality of percussion sounds

               
Measures liver span & comments on expected findings

Percuss down from clavicle and up from RLQ along the midclavicular line

               
Percuss in Traube's Space for splenic enlargement & comments on expected findings

Percuss in triangle bordered by 6th rib, anterior axillary line, & costal margin on the left side

               
Castell's method for splenic enlargement & comments on expected findings

Percuss in lowest left IC space @ the anterior axillary line during inspiration

               
Attempts to elicit costovertebral angle tenderness

Fist percussion at costovertebral angle for pyelonephritis

               
Tests for ascites & comments on expected findings

Shifting dullness and fluid wave test

               

PALPATION - Observe the student performing the following manoeuvers: (More info)

Light palpation in all 4 quadrants

Palpating for abnormalities in the abdominal wall (ex: hernia)

               
Deep palpation in all 4 quadrants

Palpating for abdominal masses

               
Palpate liver edge & comment on expected findings

Palpate up from RLQ for liver enlargement

               
Palpate for splenic enlargement & comment on expected findings

Palpate from RLQ to the LUQ

               
Ballottement of kidney
               

SPECIAL TESTS - Observe the student performing the following manoeuvers: (More info)

Rebound tenderness

Increased tenderness upon release of pressure on abdomen

               
Rovsing's sign

Tenderness in RLQ upon palpation of LLQ

               
Tenderness at McBurney's point
               
Psoas test

Pain upon passive extension of the right hip

               
Obturator test

Pain upon internal rotation of the right hip

               
Attempts to elicit Murphy's sign

Abrupt interruption of inspiration upon palpation over gallbladder

               
Offers to perform a digital rectal exam
               

GLOBAL RATING SCALES - Please rate the student on their overall performance:

Understands rational of manoeuvers and findings
                   
Organized approach
                   
Sensitivity toward patient concerns and comfort during the examination