Station Progress:

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“This patient is complaining of non-specific abdominal discomfort and nausea.  Please examine their abdomen to find out why, and discuss your findings with the examiners.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191651″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station Time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]

  1. What do you think this patient has?
  2. How would you like to investigate this patient next?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This is an example examination of a patient with a normal abdominal system.  They have no clinical signs.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]

Overview

In the abdominal station you will be provided with a brief introduction to a case, and then observed examining a patient with clinical signs (or occasionally a healthy individual without clinical signs).  Typically the introduction will give you few clues as to the underlying pathology – but sometimes may indicate that the patient has some abdominal discomfort or bloating or nausea.

In detail

Before starting, ensure your patient is adequately exposed, comfortable and lying flat on the examination couch.  Introduce yourself and ask permission to examine their abdomen.  Stand back and inspect.

Inspection

  1. From the bedside or end of the bed look for:
    1. Scars;
    2. Jaundice;
    3. Obvious ascites;
    4. Cachexia;
    5. Xanthelasmata;
    6. Gynaecomastia;
    7. Spider naevi
    8. Pigmentation;
    9. Telangiectasia;
    10. Pyoderma gangrenosum;
    11. Clubbing;
  2. In the hands look for:
    1. Clubbing;
    2. A liver flap.
  3. In the mouth look for:
    1. Mouth ulcers;
    2. Telangiectasia
  4. In the abdomen look for:
    1. Scars;
    2. Distended veins;
    3. Localised or generalised swelling;

Palpation

  1. First, enquire whether your patient has any abdominal discomfort;
  2. Systematically palpate each of the nine regions of the abdomen first gently, and then deeper;
  3. Next examine specifically for liver, kidney and splenic enlargement:
    1. For the liver start in the right iliac fossa and move your hand steadily higher feeling for an edge when your patient inspires;
    2. Start palpating for splenic enlargement in the right iliac fossa also, then moving towards the left hypochondrium.  It is not possible to palpate a spleen unless it is enlarged;
    3. Palpate for kidneys both sides using ballottement.  These are usually not palpable unless your subject is very thin.
  4. Palpate for an abdominal aortic aneurysm;
  5. Palpate systematically any masses that you’ve found;

Percussion

  1. Determine the liver span by percussing from the right iliac fossa towards the liver and continuing upwards towards the clavicle, noting when the percussion tone becomes dull then resonant again;
  2. Repeat for the spleen – again start in the right iliac fossa then working your way towards the left hypochondrium;
  3. Finally examine for shifting dullness as shown in the video above.

Auscultation

  1. Auscultate first for bowel sounds;
  2. Briefly check for renal bruits approximately 5cm above and either side of the umbilius.

Conclusion of examination

  1. Briefly palpate the patient’s ankles for any pedal oedema;
  2. Thank the patient and assist them to get comfortable again.

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”To conclude my examination I would like to examine the external genitalia, conduct a digital rectal examination, and do a urine dipstick. This patient has a clinically normal abdomen.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]