Plab 2 Revision Notes By Ali Munawar
General structure of Abdominal Examination:
History talking
1) Confirm the patient’s identity
2) Start the station well (I can see from my notes that you are here as you are having….)
• IPS: o Pick up on non-verbal cues (if the patient is holding his tummy or looks unwell)
o Build Rapport.
A) P1 o Explore the main complaint : ▪ Pain: SOCRATES. ▪ Distention: ODIPARA.
B) Associated symptoms. • Fever, nausea, Vomiting, Constipation or diarrhea, Any blood or Mucus in stool
C) Cancer Symptoms
D) Exclude other D.Ds: ▪ Ask about water works, Last stool, Pregnancy
P2 (start with an open question, then specify) - Medical Conditions (specify relevant conditions) - Medications
(specify medications relevant to the complaints) - Allergies (ask about any allergy to medications in particular)
Examination
1) Vitals 2) GPE 3) Abdominal examination
Patient Preparation (3/3/3)
Patient: For the purpose of my examination, I will look, feel, tap, and listen to different parts
of your tummy to find out the cause of your symptoms, it won`t be painful but a little bit
uncomfortable, if you feel pain you can stop me.
Doctor: Position: lay flat on your back - Exposure: below the nipple (in men), below the
breast (in women) to the mid-thigh. You can keep your undergarments on. Contra-
indication: Severe tummy pain
Both: One of the medical colleague will be present during examination acting as a chaperone. - I will be ensuring
your privacy and dignity. - Consent: Am I clear to you? Do you have any questions?, Do I have your consent to
proceed?
Examination
Go to the mannequin only after taking the consent form the patient
Inspect Look for: Distention /Scars /Umbilicus /Skin changes/ Spider nevi / Striae Visible masses/ Hernia/
Pulsation/ Peristalsis /Dilated veins/ Caput medusa
** Do not verbalize negative findings (findings that are not present during examination)
Palpate (T. T. D)
* Temperature (4 Quadrants)
* Superficial Tenderness/ palpation (The 9 quadrants of the abdomen):
o tenderness o Rebound tenderness o Guarding and rigidity
* Deep palpation (The 9 quadrants of the abdomen)
Percussion
- Shifting dullness - Fluid thrill
Auscultation
Bowel sounds: On right or left iliac fossa.
** Verbalize that in order to complete your examination, you will examine –
-Ankles for edema -Hernia orifices -DRE -External genitalia
General structure of Abdominal Examination:
History talking
1) Confirm the patient’s identity
2) Start the station well (I can see from my notes that you are here as you are having….)
• IPS: o Pick up on non-verbal cues (if the patient is holding his tummy or looks unwell)
o Build Rapport.
A) P1 o Explore the main complaint : ▪ Pain: SOCRATES. ▪ Distention: ODIPARA.
B) Associated symptoms. • Fever, nausea, Vomiting, Constipation or diarrhea, Any blood or Mucus in stool
C) Cancer Symptoms
D) Exclude other D.Ds: ▪ Ask about water works, Last stool, Pregnancy
P2 (start with an open question, then specify) - Medical Conditions (specify relevant conditions) - Medications
(specify medications relevant to the complaints) - Allergies (ask about any allergy to medications in particular)
Examination
1) Vitals 2) GPE 3) Abdominal examination
Patient Preparation (3/3/3)
Patient: For the purpose of my examination, I will look, feel, tap, and listen to different parts
of your tummy to find out the cause of your symptoms, it won`t be painful but a little bit
uncomfortable, if you feel pain you can stop me.
Doctor: Position: lay flat on your back - Exposure: below the nipple (in men), below the
breast (in women) to the mid-thigh. You can keep your undergarments on. Contra-
indication: Severe tummy pain
Both: One of the medical colleague will be present during examination acting as a chaperone. - I will be ensuring
your privacy and dignity. - Consent: Am I clear to you? Do you have any questions?, Do I have your consent to
proceed?
Examination
Go to the mannequin only after taking the consent form the patient
Inspect Look for: Distention /Scars /Umbilicus /Skin changes/ Spider nevi / Striae Visible masses/ Hernia/
Pulsation/ Peristalsis /Dilated veins/ Caput medusa
** Do not verbalize negative findings (findings that are not present during examination)
Palpate (T. T. D)
* Temperature (4 Quadrants)
* Superficial Tenderness/ palpation (The 9 quadrants of the abdomen):
o tenderness o Rebound tenderness o Guarding and rigidity
* Deep palpation (The 9 quadrants of the abdomen)
Percussion
- Shifting dullness - Fluid thrill
Auscultation
Bowel sounds: On right or left iliac fossa.
** Verbalize that in order to complete your examination, you will examine –
-Ankles for edema -Hernia orifices -DRE -External genitalia
