Special Abdominal Maneuvers (Strong Exam)

A discussion of some special maneuvers in the abdominal exam that would only be performed in specific circumstances.

0:14 Introduction
0:42 Assessment for Ascites (e.g. shifting dullness, fluid wave)
5:09 Liver Palpation
7:00 Assessment for Peritonitis (e.g. rebound tenderness)
9:33 Assessment of the Gallbladder (e.g. Murphy sign)
11:16 Assessment for Appendicitis
12:10 Abdominal Wall Tenderness Test (i.e. Carnett Test/Sign)
13:56 Abdominal Bruits for Renovascular Hypertension

References:

McGee S. Evidence Based Physical Diagnosis. 5th Ed. Elsevier; 2021.

Williams JW, Simel DL. Does This Patient Have Ascites? How To Divine Fluid In The Abdomen. JAMA. 1992; 267:2645-8.

Ma OJ, et al. Prospective Analysis of a Rapid Trauma Ultrasound Examination Performed By Emergency Physicians. J Trauma. 1995; 38: 879-85.

Trowbridge RL, et al. Does This Patient Have Acute Cholecystitis? JAMA. 2003; 289:80-6.

Wagner JM, et al. Does This Patient Have Appendicitis? JAMA. 1996; 276:1589-94.

McBurney C. Experience with Early Operative Interference In Cases of Disease of the Vermiform Appendix. NY Med J. 1889; 50: 676.

Takada T, et al. Diagnostic Usefulness of Carnett's Test in Psychogenic Abdominal Pain. Intern Med. 2011; 50:213-7.

Shian B, Larson S. Abomdinal Wall Pain: Clinical Evaluation, Differential Diagnosis, and Treatment. Am Fam Physician. 2018; 98:429-436.

#abdomen #OSCE #physicalexam

[miladkareem]

Thank you very much please continue making these clinical examination videos

[OmarBadrx]

I wish I could write in my residency personal statement that my ultimate goal is to be just like Dr. Eric Strong. This would be very truthful and would also save me a few lines

[IhtishamMD]

Thank you so much for being there for us. You are matchless and phenomenal.

[nickgowen]

Great video as always! Not only did I learn some nice things to teach on rounds, I learned at least 1 thing to use myself that I haven't done before. I was slightly surprised you didn't mention the scratch test for hepatomegaly, however. Do you dislike the scratch test, or just don't like it enough to include in the video? The way I've felt that it is useful is for trainees who feel they can't properly palpate the liver and don't know where to start. The scratch test is quick to learn and relatively easy for learners, who can then find where they think the liver edge is and then transition to standard palpation procedure as you describe. My gut, nonscientific impression has been that this has been helpful for learners' confidence and skill in exam, but I could be fooling myself.

[djmatster]

Seems to me that the vast majority of these signs and exam findings are better assessed with POCUS and Doppler. Only the assessment of rebound tenderness/peritonitis and abdominal tenderness can't be done with imaging...

[Anaben]

I could not find the video on archaic manouvers. Will it be released in the future?
Thanks so much for your work!

[alirezazakaie]

Thank you... I wanna to know the importance of liver contour auscultation to detect the size of liver ( liver scratch test )
Can you explain more?

[ashfaqafridi]

I Think only the middle Finger in kontakt with Abdomen kann produce better resonance or Dullness instead of Putting all the four Fingers on the Belly like in this Video. The Other thing is on Reaching the Dullness Point, you to shift the patient on the opposite Side sothat the Fluids shift tdown to that Direction und the Dullness converts in Resonance, called Shifting Dullness