Abdominal Examination and History Flashcards Preview

Year 3 - Clinical Communication Skills > Abdominal Examination and History > Flashcards

Flashcards in Abdominal Examination and History Deck (2)
Loading flashcards...
1

Name how to take a abdominal history

History of presenting compliant
- What have you come to see us with today?
- Do you have any other symptoms?
- How are you feeling at the moment
- How long has it gone on for
- Has this happened before and when did it start
- What does it (pain) feel like
- Do it start suddenly or a gradual onset
- Where speficially is the pain and does it spread
- What is the character of the pain
– does anything make it better or worse
- can you rate the pain on a scale of 0-10
- How are you generally – are you fit and well

Then go into more specific questions about symptoms:
- were you the only one to eat this
- what does the vomit look like
- any blood in the vomit
- any difficulty swallowing
- any difficulty breathing
- any changes in urination
- any changes in poo - do you have diarrhoea

Ideas Concerns Expectations
- Do you have any idea of what might be going on
- Is there anything that is worrying you specifically
- What were you hoping id be able to do for you today


Past Medical history
- Do you have any medical conditions
- Have you seen anyone for this before
Specific questions
- Have you had contact with those that are unwell recently
-

Drug history and allergies
- What prescribed medication do you take
- What over the counter medication do you take
- Have you taken any illicit substances?
- Do you have any allergies?

Social history
- What do you do for a living
- Do you smoke – how long have you smoked, how many cigarettes do you smoke a day
- Do you drink
- Where do you currently live
- Do you have a support network that helps you
- Do you require any assistane in day to day life
- How much exercise do you do – how often and what type


Family History
- Has your family had any significant illness
- Are they well and still alive
Systematic review
Now just before we finish I just have some quick general questions to ask
- Have you had a fever
- Any weight changes
- Do you fill fatigued
- Have you had a cough?
- Do you get any stomach pain or nausea and vomiting
- Are you going to the toilet as usually?
- Have you had a headache, any visual changes, or motor and sensory disturbances
- Any chest wall pain, or trauma
- Do you have any rashes or other skin problems

Before I examine you is there anything else that you would like to add or think that I have missed

2

How to do an abdominal examination

WIPER
- wash hands
- introduce yourself
- permissions and pain
- expose the patient
- reposition the patient lying down at a 45 degree angle

- as the patient gets on the bed look for any discomfort
- look for signs of jaundice and abdominal distention
- look for catheters and other things around the bed

hands
- look for clubning
- leukonychia
- kolionychia
- palmar erythema
- dupuytren's contratures
- pulse - rate, rhythm, character
- if the patient is jaundice and you suspect a liver failure check for a flap - carbon dioxide retention

Eye inspection
- conjuctiva palor - anemia
- yellow sclera for jaundice

Mouth
- ulcers
- dehydration
- tongue disorders - ask them to stick out there tongue

Lymph node palpitation
- supraclavicular nodes need to be particular palpated
- virchows node - left supraclavicular node that is enlarged in GI malignancy

abdominal inspection
- ask them to lie flat
- exposed from above the costal margins to the groin
- hands by the side
- ask them to lift up the top

inspect the abdomen for
- scars
- asymmetry
- distention
- dilated veins
- visible peristalsis

abdominal palpation
- ask them If they have any pain anywhere
- palpate all 9 areas first superficially and then deeply
- not that the correct position is at the same level as the patient so you are able to watch her face to see if she is in any pain
- test rebound tenderness for pressing in deeply

organ palpitation
- liver - ask them to take a few breaths in and out - move upwards pressing in as the patient inhales
- percuss the liver to assess its size
- spleen - start palpitation in the right lilac fossa and move diagonally to the left hyochodnrium
- percuss the spleen

kidneys
- place the left hand under the left loin and right hand in front and try to feel the kidney between your hands
- not normally palable

ascites
- shifting dullness and fluid thrill

percuss all 9 areas - leave the tender ones till last

auscultation
- usually listen in the right iliac fossa

complete
- hernial orficies
- external gentalia
- rectal examination