SU28.18 | Clinical Examination of Abdomen — Summary & Reflection

KEY TAKEAWAYS

The clinical examination of the abdomen is a systematic, gentle, reproducible skill. Prepare every time — consent and chaperone, expose adequately, warm hands, stand on the patient's right, ask about pain and start away from it, and orient by the nine regions / four quadrants. Then proceed in the fixed order: inspect (contour, respiratory movement, scars, veins, swellings, hernias), palpate (light for tenderness/guarding/rigidity/rebound, then deep for masses and the liver, spleen and kidneys), percuss (organ borders, liver dullness, resonant vs dull) and auscultate (bowel sounds, bruits), and complete with the hernial orifices, genitalia and per-rectal examination. Elicit the key signs — shifting dullness and fluid thrill (ascites), the spleen-versus-kidney distinction (notch, cannot get above a spleen; ballotable kidney), the parietal-versus-intra-abdominal mass test (rising/Carnett's), and peritonism. Finally, let the findings drive relevant, targeted investigations (bloods, erect chest X-ray, ultrasound, CT, ascitic tap, endoscopy) and a documented, problem-oriented treatment plan: examine, order relevant investigations, and discuss appropriate treatment.

REFLECT

Recall the last abdomen you examined, or imagine the next one. Did you prepare properly — consent, full exposure, warm hands, standing on the right, asking where it hurt and starting away from it — or did you reach straight for the abdomen and provoke guarding? When you next find a swelling, will you reach for the right bedside tests — getting above it, the notch, ballottement, the rising test, shifting dullness — before reaching for a scan? And did you complete the examination with the hernial orifices and a per-rectal examination, the parts most often skipped and most often important? Reflect on one element of the routine you tend to omit, and commit to performing the whole sequence, in order, every time until it is automatic and you can both demonstrate it and turn its findings into a sensible plan.