General Examination
What is the first thing done in the abdominal exam?
Wash hands
How is the patient exposed during abdominal exam?
Nipples to knees
How is the examiner positioned?
Seated or kneeling to the right of the bed
How is a solid organ delineated on percussion?
Dullness
What are you listening for on auscultation?
bowel and arterial sounds
What is the second thing done in abdominal exam?
Introduce yourself
What are some devices that you may see in the patient?
gastrostomy, colostomy, ileostomy
How many types of palpation are there?
2 types (light and deep)
How is the liver percussed?
ower edge (up from right iliac fossa), upper edge (mid-clavicular line;nipples)
What other areas should be examined in the abdominal exam?
lymph nodes, hernial orifices
What is the 3rd thing to do in abdominal exam?
Obtain consent from parent
What might you see on observing the abdomen?
Scars, striae
How many abdominal quadrants are there?
9
How is the spleen palpated?
From right iliac fossa to left midclavicular line
What should be examined with the abdomen but is deferred for modesty in osce?
genitalia and DRE
What must be observed during the examination?
Everything
What type of hernias might you see?
Umbilical, inguinal
What organs are palpated for?
liver, spleen, kidneys
How is ascites assessed with persussion?
Shifting dullness
What additional information may be helpful to you?
weight, height
How should the child be positioned?
Child should lie flat
What can abdominal distension be indicative of?
constipation, ascites, organomegaly, malignancy
What else may be palpated in a globally distended abdomen?
fluid thrill (if patient has ascites)
What comes after percussion?
Auscultation
What must always be done at the end of an examination?
Thank the patient and parent!