How To Examine A Patient of Abdominal Complaints

In a patient with an abdominal disorder, the following points must be asked whilst taking the history and noted on examination.

History

History is of paramount importance in clinical examination. It enables you to narrow your examination to a region and also guides you about the likelihood of particular disorder. Following points should be asked in patient of abdominal complaints. These points cover whole abdomen in general and can be individualized depending upon the complaint.

• Anorexia, nausea, vomiting
• Dysphagia, flatulence, eructation
• Retrosternal burning, water brash
• Diarrhea, constipation, clay stools, worms in stools, mucus in stools
• Abdominal pain, abdominal lump, abdominal distension
• Hematemesis, melena, epistaxis, bleeding per rectum
• Jaundice, gynecomastia, libido, loss of hair
• Fever, weight loss
• Alcohol, smoking
• Past history of tuberculosis, malaria, kala-azar, leukemia, hemolytic crisis (sudden pallor and dyspnea) and drugs

General Examination

• Built and nutrition
• Nails and conjunctiva: Pallor, clubbing, cyanosis, icterus, etc.
• Edema of feet, lymphadenopathy, JVP
• Blood pressure
• Signs of liver cell failure: Scanty hair, palmarerythema, spider nevi, parotid swelling, gynecomastia, testicular atrophy, Dupuytren’s contractures.
• Miscellaneous: Bony tenderness, petechiae, genitals

An overview of Alimentary System Examination

Oral cavity

Teeth, Tonsils, Tongue, Oropharynx

Abdomen

Inspection:

Shape of abdomen, Umbilicus, Abdominal movements, Pulsations, Dilated veins, Peristalsis, Hernial orifices, Scars and sinuses, Skin.

Palpation:

1. Tenderness, guarding and rigidity
2. Liver, spleen, kidney, gall-bladder, colon, or any other lump (Its size, surface, borders, tenderness and bruit)
3. Fluid thrill

Percussion:

1. Horse-shoe and shifting dullness
2. Dullness over any lump, if palpable.

Auscultation:

Peristalsis, Rub, Bruit

Miscellaneous:

Abdominal girth, PR, Proctoscopy