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Introduces self
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Confirms name & age of patient
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Explains & gains consent
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Washes hands
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Exposes patient from nipple to knees and lies them flat
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Asks if patient is in pain
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General inspection around bed and patient for scars, distension,
stoma sites, hernias, drains and lines
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Inspects hands for clubbing, leukonychia, koilonychia, dupuytren's
contracture, palmer erythema
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Looks for asterixis (liver flap)
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Inspects eyes for jaundice, conjunctival pallor, xanthelasma
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Inspects mouth for Peutz-Jeghers brown freckles, central cyanosis,
macroglossis, glositis, dryness, ulcers
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Offers to inspect jugular venous pulse
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Inspects chest for loss of axillary hair, gynecomastia and spider
naevi
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Feels Virchow's node in the left supraclavicular fossa
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Inspects abdomen closely for masses, hernias, scars, peristaltic
movements
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Asks patient to cough to bring out any hernias
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Palpates all regions lightly whilst looking at patient for signs of
pain. Also looks for guarding, rebound tenderness and rigidity
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Palpates deeply for masses and tenderness
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Identifies features of masses (site, size, shape, edge, consistency,
percussion note, bowel sounds)
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Palpates for liver from right iliac fossa on deep breathing. If
enlarged, describes edge
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Palpates for spleen from right iliac fossa to left hypochondrium
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Ballots kidneys on inspiration
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Feels for an aortic aneurysm
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Percusses for the upper and lower borders of the liver
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Percusses for the spleen asking patient to roll over to percuss
behind
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Percusses for suprapubic dullness (bladder distension)
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Percusses for shifting dullness of ascites (waiting 30 seconds after
patient rolls over)
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Auscultates for bowel sounds for at least 30 seconds
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Auscultates for renal and aortic bruits
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Thanks patient and offers help to redress
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Washes hands
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Requests full inguinal exam including examination of the external
genitalia, digital rectal examination and urinalysis
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Summarise appropriately with only key findings.
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Offer appropriate differential diagnoses.
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Patient global score
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Potential differentials
- Renal transplant (iliac fossa scar with underlying kidney, look for AV fistula and palpable kidneys suggestive of polycystic kidney disease and oral candida/bruising for steroids)
- Scars - have differentials ready for the common scars
- Hernias - perform a quick hernia exam
- Stomas - examine the stoma identifying the type (ileostomy, colostomy)
- Enlarged liver - cirrhosis (80%), carcinoma, cardiac failure, infectious