Benchmarks for the Abdominal Exam
On completion of FCM, you should be able to demonstrate each of the following on a patient or on an Objective Structured Clinical Encounter (OSCE):
Inspection
- Observe your patient for increased discomfort with movement.
- Inspect the abdominal contour, observing for distention or masses.
- Inspect the skin as you examine the abdomen, noting scars and skin lesions
Auscultation
- Listen in one place with the diaphragm of the stethoscope until you hear bowel sounds.
Percussion
- Percuss all four quadrants, observing for tenderness and tympany
- Percuss the upper and lower liver margins in the R mid-clavicular line
Palpation
- Palpate all 4 quadrants for tenderness or masses
- Palpate the lower liver edge
- Palpate for an enlarged spleen
Recognize and interpret common findings on the abdominal exam:
- Auscultation: Absent bowel sounds, tinkling bowel sounds
- Percussion: Percussion tenderness
- Palpation: Rigidity, guarding, abnormal liver edge, splenomegaly
Perform hypothesis driven exam maneuvers:
- If you suspect renovascular hypertension: Listen for renal artery bruits.
- If you suspect appendicitis: Assess for McBurney’s point tenderness
- If you suspect cholecystitis: Assess for Murphy’s sign
- If you suspect ascites: Test for a fluid wave and shifting dullness
- If you suspect aortic aneurysm: Assess the diameter of the abdominal aorta using palpation.