Abdominal Examination

  • Acute Abdomen (as the presenting complaint) [Hours-Days]
    • Acute Appendicitis +/- Peritonitis: History of migration of site of pain + Worse on Movement + Associated with N&V + Fever + On examination (McBurney's sign positive + Rebound tenderness positive + Rovsing's sign positive) +/- signs and symptoms of accompanying peritonitis (Fullness in history, rigidity on palpation, hypoactive bowel sounds on auscultation)
    • Biliary disease: (NEW)
      • Biliary Colic (RUQ Pain only): Comes in waves (colicky) + Radiates to right shoulder + Aggravated by fatty meals.
      • Acute Cholecystitis (RUQ Pain + Fever) [most common]. Murphy's sign positive on examination.
      • Acute Cholangitis (Charcot's Triad: RUQ Pain + Fever + Jaundice).
    • Pancreatitis:
      • Acute Pancreatitis (Scenario A): Radiates to back + Relieved by leaning forward + Vomiting + Heavy drinker
      • Acute-on-Chronic Pancreatitis (Scenario B): Acute pancreatitis history + Previous similar episodes resolved on own + Weight loss + Steatorrhea + History of diabetes mellitus
    • Intestinal Obstruction: Holding stomach/requesting painkillers + Associated Nausea + Constipation (no stool) or obstipation (no stool or gas) +/- history of weight loss and chronic change in bowel habit over several months (if present suggests underlying colorectal cancer as the cause) + Hyperactive or high pitched tinkling bowel sounds on examination (clincher). Note: if imaging requested, examiner may give you an AXR or CT showing dilated bowel loops +/- air fluid levels
    • Ectopic Pregnancy: T1 pregnancy (8wks) + Risk factors (IUCD, previous STI) + On examination tenderness in RIF/LIF
  • Chronic Abdominal Pain (as the presenting complaint) [Months]
    • Chronic PID: Foul vaginal discharge + Recent change in partner + Does not practise safe sex + History of previous C-Section (history of depression on sertraline is a distractor) + On examination lower abdominal tenderness
  • Abdominal Distension (as the presenting complaint)
    • Alcohol-Related Liver Disease: Distention + Very heavy drinker e.g. 20-30 units of vodka per day + Shifting dullness positive on examination
    • Suspected Ovarian Cancer: Post-menopausal woman + Bloating + Feeling of fullness + Pelvic pain + Normal bowels + Weight loss/loss of appetite + Family history of breast/ovarian cancer first degree relative + Shifting dullness positive on examination
    • Heart Failure: Abdominal swelling + SOB + Leg/Scrotal swelling + History of IHD/MIs + Recently stopped Furosemide due to nocturia + On examination (O2 sats low + B/L creps in bases + Distended abdomen with shifting dullness positive (ascites) + B/L pitting oedema of legs, extending to the groin)
  • Back Pain (as the presenting complaint)
    • Symptomatic Abdominal Aortic Aneurysm (AAA): gradual onset back pain for last 24 hours + Hypertensive + On examination: Pulsatile (expansile) epigastric mass
  • Confusion (as the presenting complaint)
    • UTI with Urinary Retention secondary to BPH: Confused elderly man e.g. shouting at daughter + Fever + Urinary frequency + History of BPH + On Examination (Bladder distended, palpable + Prostate enlarged, smooth + Urine dipstick positive for nitrites)
  • Diarrhoea (as the presenting complaint)
    • Inflammatory Bowel Disease (IBD): Middle-aged + Chronic diarrhoea for 2 months (5-6 motions per day) + LIF pain (likely UC) + Weight loss +/- Fever (Can be without manikin)
    • Irritable Bowel Syndrome (IBS): long-standing (40+ years) alternating diarrhoea/constipation + Other bowel symptoms (bloating, abdominal pain) + no red flag symptoms + stool test negative (Can be without manikin)
  • Tiredness (as the presenting complaint)
    • Suspected Leukaemia - First Presentation (No Manikin, Direct Exam): 26-year-old man (or a 60-year-old man) presents to GP with tiredness associated with: weight loss + easy bruising and gum bleeding + recurrent chest infections + On general examination: bleeding gums / skin bruising + On abdominal examination: hepatosplenomegaly
    • Suspected Upper Gastrointestinal Tract Cancer (Stomach, Oesophagus): 60-year-old man with tiredness for 6 months + weight loss + palpitations + long-standing acid reflux + recent history of recurrent chest infections + On examination: abdominal and chest examinations normal (NEW)
      • Scenario B: Presents with Indigestion as primary complaint + abdominal pain for 2 weeks + FLAWS positive + history of peptic ulcer 5 years ago + On Ex: severe pain in epigastric region.


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