Abdominal Examination, Demonstration of all steps, Part 1

An abdominal examination is a physical examination of the abdomen, typically involving inspection, auscultation, palpation, and percussion, to assess for signs of disease or abnormalities in the abdominal organs and surrounding tissues. 

Here's a more detailed breakdown:

1. Preparation:

Positioning:

The patient should be positioned supine (lying on their back) with knees slightly bent and arms at their sides. 

Expose the abdomen:

Adequately expose the abdomen from the waist up, while maintaining patient privacy. 

Good lighting:

Ensure adequate lighting for proper inspection. 

Warm hands and stethoscope:

Use a pre-warmed stethoscope and ensure your hands are warm to avoid startling the patient. 

2. Examination Techniques:

Inspection:

General appearance: Observe the overall appearance of the abdomen, noting any signs of distension, masses, or asymmetry. 

Skin: Look for scars, striae, rashes, or discoloration. 

Umbilicus: Inspect the umbilicus for any abnormalities. 

Movement: Observe for any pulsations or peristaltic waves. 

Auscultation:

Bowel sounds: Listen for bowel sounds in all four quadrants, noting their frequency, character, and presence of any abnormal sounds like borborygmi (rumbling sounds). 

Vascular sounds: Listen for bruits (abnormal sounds) over the abdominal aorta and renal arteries. 

Palpation:

Light palpation: Gently palpate the abdomen to assess for tenderness, masses, or guarding (tensing of the abdominal muscles). 

Deep palpation: Palpate deeper to assess for organomegaly (enlarged organs), masses, or tenderness. 

Specific organ palpation: Palpate for the liver, spleen, kidneys, and other organs as needed. 

Percussion:

General percussion: Percuss the abdomen to assess for fluid, gas, or masses. 

Percussion of specific organs: Percuss the liver and spleen to assess their size and position. 

3. Key Areas to Assess:
Suprapubic area: Palpate for a distended bladder.
Umbilical area: Palpate for masses or pulsations.
Flanks: Palpate for kidney masses or tenderness.
Lower quadrants: Palpate for masses or tenderness.
4. Special Tests:
Shifting dullness:
Test for ascites (fluid in the abdominal cavity) by percussing the abdomen and noting any shifting dullness.
Rebound tenderness:
Assess for peritoneal irritation by gently palpating the abdomen and then rapidly releasing your fingers.
Guarding:
Assess for guarding (tensing of the abdominal muscles) by palpating the abdomen.
5. Documentation:
Record your findings:
Document all your findings in a clear and concise manner, including any abnormalities or tenderness.
Include patient history:
Include relevant patient history, such as any past abdominal surgeries or symptoms.