Comprehensive Notes on Abdominal Examination

Abdominal Examination: Comprehensive Study Notes

I. Preparation and Initial Setup

  • Patient Positioning:

    • Instruct the patient (Mrs. Chua) to raise her gown just below her breasts.

    • Lower the examination area slightly to ensure good visibility and inspection of the abdomen.

    • Have the patient bend their knees up to relax the abdominal muscles, facilitating a more effective exam.

II. Inspection

  • General Abdominal Inspection: Carefully inspect the abdomen for:

    • Any obvious masses.

    • Presence of hernias.

    • Visible pulsations.

  • Hernia Check (Dynamic): Ask the patient to bring their head up briefly to increase intra-abdominal pressure, specifically checking for any emergent hernias.

III. Auscultation

  • Bowel Sounds:

    • Auscultate at a minimum of four abdominal quadrants.

    • Finding: Positive bowel sounds were noted in all four quadrants, indicating normal gut motility.

  • Aortic Auscultation:

    • Auscultate the aorta using the bell of the stethoscope.

    • Finding: No bruits were detected in the aorta, ruling out turbulent blood flow often associated with aortic stenosis or aneurysm.

  • Femoral Bruits: Auscultate for femoral bruits in both inguinal regions (performed after palpation of the region).

IV. Percussion

  • Abdominal Quadrants: Percuss all abdominal quadrants to assess for general tympany (gas) or dullness (solids, fluid).

  • Liver Size: Percuss to determine the size of the liver.

    • Expected Range: The liver span should typically be between approximately 66 and 1212 cm at the midclavicular line.

V. Palpation

  • Light Palpation:

    • Perform light palpation across the entire abdomen.

    • Continuously ask the patient if they experience any discomfort during this process.

  • Deep Palpation:

    • Follow with deeper palpation, again inquiring about any discomfort or tenderness.

  • Liver Palpation:

    • Ask the patient to breathe in and out deeply while palpating to feel the liver edge as it descends with inspiration.

  • Spleen Palpation:

    • Similarly, ask the patient to breathe in and out deeply while palpating, attempting to feel the spleen (which is typically not palpable in healthy individuals).

  • Kidney Palpation:

    • Palpate for the kidneys, usually using a bimanual technique.

  • Aortic Palpation:

    • Palpate to assess the size of the abdominal aorta.

    • Finding: The aortic size was noted as very normal, indicating no abnormal widening.

VI. Inguinal Region Examination (Bilateral)

  • Preparation: Instruct the patient to straighten their legs and hold their underwear to the side to expose the inguinal area.

  • Right Side Examination:

    • Palpation: Palpate for:

      • Femoral hernias.

      • Femoral pulses (assessing strength and rhythm).

      • Inguinal nodes (checking for enlargement or tenderness).

    • Auscultation: Auscultate for femoral bruits.

  • Left Side Examination:

    • Repeat the same complete examination steps as on the right side:

      • Auscultate first.

      • Palpate for femoral pulses.

      • Palpate for femoral hernias.

      • Palpate for inguinal nodes.

  • Overall Finding: The findings for both sides were considered "very good," suggesting no abnormalities found in the inguinal regions.