Preparations & Draping

• Wash hands
• Laying flat on bed, arms by their sides
• Expose abdomen from below the nipples to pubic bone

For this exam, I need to expose your stomach, so I need to expose from below your nipples to your waist. Is that OK? Can you lower the gown by yourself or would you like for me to help you with that?

Inspection

• General
  • Head to toe (level of consciousness, obvious breathing difficulties, general descriptions)
  • Abdominal scars and masses (previous surgeries)
  • Abdominal contour and symmetry
    • Distension
    • Scaphoid (concave; can indicate malnutrition, dehydration and/or cancer)
    • Visible organs, masses, pulsations
  • Jaundice (sclera and frenulum of the tongue)
  • Ascites (look for bulging flanks from foot of bed)
  • Ecchymosis (hemorrhagic spots)
    • Periumbilical: Cullen’s Sign, indicating pancreatitis
    • Flank: Grey Turner’s Sign, indicating pancreatitis
  • Hypertrophy, atrophy, scars, skin lesions or dilated veins
    • Caput medusae

Auscultation

<aside> 💡 Must be performed before percussion and palpation, as percussion and palpation will shift abdominal contents.

</aside>

• Bowel Sounds

  • Over all 4 quadrants
  • Then over peri-umbilical area (left, center, right)
  • Note absence or presence of bowel sounds
    • Clicks & gurgles every 5-10 seconds
    • Absence of bowel sound
    • High-pitched bowel sound

• Vascular Bruits

  • Abdominal aorta (2 cm above umbilicus)
  • Renal arteries (2 cm either side of aorta)
  • Iliac arteries (halfway between umbilicus and ASIS on both sides)
  • Femoral arteries (halfway between ASIS and pubic symphysis)
    • Can skip and simply verbalize (since exam is in sensitive area)