M K ALAM

Abdomen extends from the nipple level to the bottom of the pelvis

Exposure: nipples to knees (ideal) Patient lying flat on a pillow Arms by the side ( not under the

head!) Sit or kneel beside the patient Adequate light

Asymmetry (from the foot end of the bed)

Movement with breathing Scar, sinus, wound Prominent veins Shape of the umbilicus Cough impulse ( groin, umbilicus, scar)

Gentle palpation: for tenderness start away from the area of pain

Deep palpation: for tenderness

Guarding: muscle contracted overlying the tender area

Rebound tenderness: sudden release causes sharp pain

Organomegaly: liver , spleen, kidneys

Other masses

Cough impulse

Percussion Organs and masses Liver span Ascites: fluid thrill, shifting dullness

Auscultation Bowel sounds: normal, increased, absent

Bruit Succussion splash

External genitalia

Rectal examination: left lateral position, hip flexed to 90º and knee flexed to less than 90°

•Inspection•Palpation

• CLINICAL DIAGNOSIS

• INVESTIGATIONS

• FINAL DIAGNOSIS

• TREATMENT