Examination of the abdomen

Abstract

Checklist WIPER Physiological parameters • Check peripheries for stigmata of abdominal disease. Inspection • Skin : scars, stomas, sinuses/fistulas, distended veins, drains Ask patient to cough. Observe for pain, peritoneal irritation, hernias or musculoskeletal pain . • Abdominal wall : hernias (cough + head-up + heels off bed): inspect ventral abdominal wall, umbilicus, groins and scars • Abdominal cavity : distension, pulsations, masses, visible peristalsis • Flanks : scars, flank bulges Ask patient to lean forward. Inspect for hernias as patient strains . • Back : scars, sacral oedema, pressure ulceration • Ankles : peripheral oedema, calf swelling Palpation Kneel and look at patient's face to identify discomfort during palpation • Light palpation, four quadrants: identify peritonitis, distension, musculoskeletal pain (use four fingers of one hand). • Deep palpation, nine regions: identify masses, organomegaly, rebound tendernes , guarding (use two hands). • Liver, gallbladder and spleen → on inspiration • Kidneys → ballot with two hands • Aorta → lateral to medial palpation with two hands • Scars: incisional hernias → cough • Groins: inguinal and femoral hernias, inguinal lymph nodes → cough • Scrotum • Lower ribs and pelvis • Specific abdominal signs (see table on pages 49 – 50) Percussion • Percussion tenderness: peritoneal irritation • Ascites: dullness in flanks, shifting dullness, fluid thrill • Liver size, spleen size • Palpable bladder Auscultation • Bowel sounds • Abdominal aortic aneurysm bruit • Renal artery stenosis bruit • Liver/splenic bruits To complete the examination… • Digital rectal examination • External genitalia • Urine dipstick Examination notes The examination of the abdomen is a broad screening examination that may lead to a focused assessment of other systems. It remains the trademark examination of the general surgeon. A systematic anatomical approach is needed to provide an authoritative opinion. The examination of the abdomen can be structured around three anatomical layers: skin, abdominal wall and abdominal content.