Abdominal Exam

A well-conducted examination of the abdomen can reveal a great deal of information but, if it is poorly performed, it can reveal nothing and lose the patient's confidence if it causes pain. Everyone develops a personal technique with time and adjusts it according to circumstances. Emphasis will be different if the problem is an acute abdomen or an abdominal mass. Not all of what is described below needs to be performed in full every time, but knowledge of the full routine is important so that all parts may be brought in as required.

Preparation

  • The patient should be adequately undressed (from xiphisternum to pubis) and lying comfortably with the head a little elevated and well supported (one pillow). The arms should be placed alongside the body. This relaxes the abdominal muscles.
  • A warm room, comfortable patient and a calm and reassuring approach from the doctor will create the necessary relaxation. If the patient is tense, very little information can be gained and if you hurt the patient there will be tension and loss of confidence.
  • Explain what you are about to do and ask permission to start.
  • ,li> Your own comfort is also important. The height of the examination couch should permit a comfortable examination whilst standing upright. A bed in a patient's home is usually lower, and sitting on a chair may be preferable.
  • Obesity and a pendulous abdomen may make the examination more difficult. Indications
  • The abdominal examination is part of all comprehensive examinations of all patients of all ages. These may be routine, scheduled examinations, or examinations to address nonspecific symptoms such as fever, weight loss, lethargy, loss of appetite, and nausea. It is an essential component of the evaluation of the patient with abdominal trauma (see images below), or generalized trauma which may include abdominal organs. It is the primary focus of the evaluation of a patient whose chief symptom is related to any type of abdominal signs or symptoms including, but not limited to, the terms listed above and to any suspected pathology in the gastrointestinal tract. If life-threatening intestinal pathology exists, most commonly obstruction, perforation, ischemia, or volvulus, a rapid and diagnostic abdominal examination will be the single most important factor to avoid mortality and to minimize morbidity.

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