A stepbystep guide to performing an abdominal examination in an osce setting, with an included video demonstration. Other examinations and tests are used in conjunction with the abdominal examination, for example ultrasonic scan. Consider summarizing key history and physical exam. Abdominal examination fluid thrill place the palm of your left hand against the left side of the abdomen flick a finger against the right side of the abdomen ask the patient to put the edge of a hand on the midline of the abdomen if a ripple is felt upon flicking we call it a fluid thrill ascites. The basic methods of physical examination 1 inspection 2 palpation 3 percussion 4 auscultation 5 smelling. Pcm guidebook for history taking and physical exams. In the initial presentation, full physical examination should be done. With abdominal assessment, you inspect first, then auscultate, percuss, and palpate. Maximum cervical rotary compresion positive negative for nerve root compression. Start studying chapter 7 history and physical examination.
The difference is based on the fact that physical handling of peritoneal contents may alter the frequency of bowel sounds. The pocket guide to physical examination and history taking, 7th edition is a concise, portable text that. More specific physical findings in appendicitis are rebound tenderness, pain on percussion, rigidity, and guarding. For health science students physical diagnosis editors gashaw messele mensur osman zeki abdurahman university of gondar in collaboration with the ethiopia public health training initiative, the carter center, the ethiopia ministry of health, and the ethiopia ministry of education 2005. The prevalence of recurrent upper abdominal discomfort or pain in the united states and other western countries is approximately 25%.
Abdominal pelvic examination remains important exam for pregnant women because it is the easiest method of fetal monitoring. Performance of physical examination skills in medical. The charting system used for all patients in the emergency department is a template chart with boxes that are checked if a portion of physical exam is performed. Crosssectional, dynamic, and the other methods of abdominal imaging are nowadays thought by some to supplant physical examination, but the latter should. Though there is a large difference in the modes of education, curricula, course content, and. Classically, abdominal physical examination com prises inspection, auscultation, percussion, palpation, and special maneuvers. Subheadings in all caps and flush left to the margin. The abdominal examination is conventionally split into four. Abdominal examination physical examination for osce 1. The abdominal examination introduction introduce yourself wash hands briefly explain to the patient what the examination involves position the patient flat general inspection assess the patient from the end of the bed obvious discomfort or distention jaundice the hand and arm. This is a good point to inspect the skin of the arms and trunk, especially the abdomen, for. Abdominal examination physical examination for osce.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. The patient is a xyearold welldeveloped, wellnourished malefemale in no acute distress. Ascites observe distention, bulging flanks palpation no evidence of mass below diaphragm percussion shifting dullness enlarged liver hepatomegaly percussion indicates extension of liver palpation confirms location of lower edge also detects contour, texture. For the examiner examination is done in warm room with good light the examiner must warm his hands, has short finger nails and use warm stethoscope 2.
Common complaints anorexia nausea vomiting dysphagia flatulance retrosternal burning diarrhoea constipation clay colour stool wormsmucous in stool black tarry stool abdominal pain lump abdominal distension hematemesis melena epistaxis. Introduction to the practice of medicine ii examination of the. Bates pocket guide to physical examination and history taking. Obstetric physical examination 1 obstetric physical examination. Chapter 7 history and physical examination flashcards. Pt should be lying supine, relaxed, draped, with hands at sides or crossed on chest. Inspection, auscultation, palpation, and percussion of the abdomen.
An example of a history, physical examination, presentation and problem solving practical examination station department of internal medicine, the university of texas medical branch this packet contains an example of a history, physical examination, presentation and problem solving hppp practical examination station couplet used in the internal. Although rif tenderness is present in 96% of patients, this is a nonspecific finding and can be present in a number of other conditions presenting as acute abdomen. Another physical sign of ascites is demonstration of a transmitted fluid wave. Demonstrate the proper techniques used for the abdominal exam inspection, auscultation, palpation, and percussion. Physical examination inspection, palpation, percussion, auscultation, vital signs, weight, height 3. This is essentially an examination of the patients abdomen. Inspection consists of visual examination of the abdomen with note made of the shape of the abdomen, skin abnormalities, abdominal masses, and the movement of the abdominal wall with respiration. Children swallow a large amount of air when they cry and gastric distension may require nasogastric tube decompression. An abdominal examination is a portion of the physical examination which a physician or nurse uses to clinically observe the abdomen of a patient for signs of disease. The examination must be comprehensive and also focus on specific assessments that are appropriate for the childs or adolescents age, developmental phase, and needs.
Recent onset hypertension and abdominal bruit this combination raises the possibility of a secondary cause of hypertension, specifically ascvd of the renal artery leading to renovascular hypertension. It is a fundamental examining method, proceeded by the sense organs such as eyes, ears, nose and hands or simple tools stethoscope and plexor. The third patient was referred to her primary care physician, and ultrasound examination of the. Reliable physical examination of patients presenting with acute abdominal pain and tenderness is necessary for identifying serious causes on the one hand, and for preventing further unnecessary.
General principles of exam abdominal examination the history and physical in perspective 70% of diagnoses can be made based on history alone. Blunt force injuries to the abdomen can generally be explained by 3. It is a complex procedure which also includes examination of other parts of the body including the hands, face and neck. Its findings can be used to detect peritonitis and other acute and subtle abnormalities of the abdomen. Acute appendicitis physical examination acute abdomen. The clinical anatomy of the physical examination of the abdomen. These pro cedures are explained in detail in this chapter and are available on at. Normal physical exam template samples mt sample reports.
Examination for abdominal aortic aneurysm aaa has sensitivity of. A necessary step for primary care physical therapists article pdf available october 2015 with 250 reads how we measure reads. Describes how to interview the patient and take the health history. It is through the tactile sensation of touch that abdominal tenderness is detected and expressed through pain. Penetrating abdominal trauma clinical presentation. An evaluation of the core physical exam in patients with. Abdominal palpation is a difficult skill to master in the physical examination. The abdominal examination aims to pick up on any gastrointestinal pathology that may be causing a patient. The physical examination is a more reliable indicator for surgical intervention with penetrating abdominal trauma than with blunt trauma.
The physical examination of the abdomen is an abstract art based on empiricism and tradition, and although not evidencebased for the most part, yet it is still an integral part of the clinical evaluation. Neck compresion positive negative for right left nerve compression. After completing the foundations of clinical medicine, you should be able to perform a comprehensive abdominal exam. Mb chb clinical history and examination manual university of. Gastrointestinal examination and questions for doctors, medical student exams, finals, osces and mrcp paces. A necessary step for primary care physical therapists. The skin and contour of the abdomen are inspected, followed by auscultation, percussion, and palpation. For more information refer to a guide to physical examination and history taking, pdf. Full gastrointestinal physical examination see also pdf resources. Abdominal exam university of california, san diego. The examination begins with the patient in supine position, with the abdomen completely exposed. Inspection, auscultation, palpation, and percussion of the. The lack of hypertensive retinopathy and left ventricular hypertrophy on physical examination further support a recent onset of her bp. Physical examination a complete physical examination is included as part of every bright futures visit.
Reminds students of common, normal, and abnormal physical. Scratch marks pruritis is a feature of cholestatic liver disease bruising due to impaired clotting factor production in liver failures. Paediatric abdominal examination osce guide geeky medics. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. Introduction wiipppe wash your hands ensure that your hands are clean and warm with short nails. Abnormalities detected on inspection provide clues to intra abdominal pathology. She can be reassured regarding fetal growth and fetal wellbeing. Student source pom1 physical exam abdomen exam introduction the best way to prepare yourself for your small group exercises is to first watch the abdominal exam video from beginning to end, then proceed through all the explanations of abdominal anatomy and physiology that follow. Abdominal examination includes observation of external signs, then palpation for tenderness, distension, or firmness. Both patients with abdominal pain of musculoskeletal origin showed marked improvement in pain and disability after 7 treatment sessions. Abdominal examination detailed oxford medical education.
The pe of the abdomen must be performed in an organized, systematic fashion in order to yield accurate and consistent results. At many trauma centers, repeated abdominal examinations are the preferred approach for managing hemodynamically stable patients with penetrating abdominal stab wounds. Palpation is the examination of the abdomen for crepitus of the abdominal wall. The physical examination typically occurs after a thorough medical history is taken, that is, after the physician asks the patient the course of their symptoms. Physical exam session 3 examination of the abdomen. Web site design by jan thompson, program representative, ucsd school of medicine. A paediatric abdominal examination is generally performed in one of three major clinical settings as part of a routine clinical examination, in the assessment of. Ucsds practical guide to clinical medicine a comprehensive physical examination and clinical education site for medical students and other health care professionals. State of development in relationship to chronological age c. Abdominal examination abdominal examination during pregnancy abdominal examination provides the woman with information that pregnancy is progressing well. Physical diagnosis of the abdomen university of virginia.
This portion of the visit builds on the history gathered earlier. Examination of the gastrointestinal system detailed. Place your abdominal hand midway between the umbilicus and the. Abdominal examination knowledge for medical students and. Gilbert, in pediatric critical care fourth edition, 2011. Physical examination of patients with acute abdominal. A fundamental part of physical examination is examination of the abdomen, which consists of inspection, auscultation, percussion, and palpation. Abdominal examination an overview sciencedirect topics. Physical examination pdf physical examination of the chest and lungs. Expensive tests often confirm what is found during the history and physical equipment for physical examination. Intraabdominal injuries secondary to blunt force are attributed to collisions between the injured person and the external environment and to acceleration or deceleration forces acting on the persons internal organs.