The abdominal examination - Qpercom

Introduction
For a proper physical examination, the examination room should meet the following requirements:

clean, draught-free, well-ventilated and heated;
adequate privacy (separate changing room, doors that close securely, no views from outside, and preferably no telephones or open entrances);
sufficient space in which to manoeuvre;
adequate lighting;
Daylight or fluorescent lighting; preferably not incandescent lighting, which can interfere with assessment of the colour of a patient’s face or sclerae; also have a separate examination lamp that will cast shadows when directed at a slant, which can help detect slight curvatures.
as little noise as possible;
an examination table with a flat, hard surface covered in clean paper and a nearby footstool;
an adjustable stool, so that the physician can sit next to the patient;
any necessary materials (e.g. examination gloves, lubricant) should be clean, warm and at hand.

Before the examination

Explain to the patient what the examination entails, including what the physician will do and what the patient is expected to do.
Provide clear undressing instructions.
The regions that will be examined must be sufficiently exposed. Do not have the patient undress more than is necessary.
The patient should have an empty bladder and vaginal tampons should be removed (if necessary, allow the patient time to use the lavatory before the examination).
Remove any jewellery from your fingers and wrists and wash your hands while the patient undresses [Figure 5]; ensure that your hands are clean and warm and your fingernails are short.

Figure 5

Starting the examination

Ask the patient to lie down on the examination table and relax.
The head should be elevated approximately 30° [6] using a head support or pillow, the arms should be extended along the body and relaxed, and the legs should also be extended; in the case of severe pain, the legs may be bent slightly (and supported by a pillow if necessary [Figure 7]).
Sit on the right side of the patient (if you are left-handed, sit on the left side).
Adjust the table or stool to the appropriate height.
The patient’s abdomen should be at elbow-height of the sitting physician.

Figure 7

General points to consider during an examination

Approach the patient calmly and avoid abrupt movements.
Check the face of the patient repeatedly during the abdominal examination, noting any grimaces of pain.
Distract a restless or nervous patient by talking or posing questions.
Repeat an examination technique if uncertain.
For each abdominal examination, also consider examination of the:
- supraclavicular lymph nodes
- groin
- genitalia
- anal region.

Examination procedure

Begin with an assessment of the patient’s general condition. Is the patient severely ill, anxious, lucid? Note the patient’s pulse rate [Figure 8], blood pressure, body temperature, colouration and respiration.
Assess the nutritional status of the patient and the skin turgor, i.e. whether dehydration is possible [Figure 9].
Follow a set procedure for the abdominal examination:
- inspection (looking)
- auscultation (listening)
- percussion (tapping)
- palpation (feeling)
  By following this examination sequence, the discomfort experienced by the patient is gradually increased. The advantage of this sequence is that the examination techniques do not negatively influence one another (for example, percussion and palpation can cause intestinal peristalsis to increase).

Figure 8: The pulse is the abdominal barometer

Figure 9: Assessing the skin turgor

After the examination