Wednesday, July 20, 2016

Common mistakes in Per Abdominal examination

1. Forgetting to Expose abdomen adequately:
Before examination, patient should ideally be exposed from nipples to mid thigh. Failure to do so may lead to missing findings during examination eg. Hernia



2. Abdominal symmetry and movement: Should be examined tangentially and from leg end. Comment should be made on movement of all quadrants with respiration.

3. Forgetting to relax abdomen before palpation:
Flex the legs at knees and arms should be by side of body. Head should be rested on a pillow. Only after abdomen is in relaxed position palpation should be proceeded.

4. Missing points on palpation:
a. Remember to ask for pain in any site before palpating. The part with pain should be skipped and palpated at the end.
b. Look for rigidity and guarding besides tenderness.
c. Tenderness should be assessed by looking at facial expression +/- guarding
d. Remember to palpate urinary bladder
e. Hernial orifices should be palpated and is commonly missed point.
f. Make the patient sit and check for renal angle fullness and tenderness.


Rarely grading can be asked.


5. Remember- Shifting dullness is done in percussion and fluid thrill is done in palpation, in a patient with abdominal distension.

6. Auscultation- Look for Renal bruit, Hepatic bruit etc in indicated cases. Bowel sound  should be listened to. When bowel sounds are not present, one should listen for a full 3 minutes before determining that bowel sounds are, in fact, absent.



Recommended reading
https://meded.ucsd.edu/clinicalmed/abdomen.htm
http://www.ncbi.nlm.nih.gov/books/NBK420/

2 comments:

  1. please can you give clarity on fluid thrill

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    Replies
    1. Fluid thrill is done to detect free fluid in abdomen as in ascites, specially when amount of fluid is massive, fluid thrill is positive.
      It is performed by striking on one side of abdomen in supine posture and feeling the water thrust on other side. An occulsion, usually patient's hand is kept in midline to prevent trasmission of waves via fat layer.

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