Paediatric Abdominal Exam

Introduces self	0	1
Confirms name & age of patient	0	1
Explains & gains consent from parents and child	0	1
Washes hands	0	1
Exposes patient from nipple to knees and lies them flat	0	1
Asks if patient is in pain	0	1
Asks to see red book to check growth and vaccination history. Offers to plot current height and weight	0	1
General inspection around bed and patient for scars, distension, abdominal movements, stoma sites, hernias, drains and lines	0	1
Inspects hands for clubbing, leukonychia, koilonychia, palmer erythema	0	1
Looks for asterixis or flapping tremor	0	1
Inspects eyes for jaundice, conjunctival pallor	0	1
Inspects mouth for Peutz-Jeghers brown freckles, central cyanosis, macroglossis, glositis, dryness, ulcers	0	1
Offers to inspect jugular venous pulse	0	1
Inspects chest for spider naevi	0	1
Feels Virchow’s node in the left supraclavicular fossa	0	1
Inspects abdomen closely for masses, hernias, scars, peristaltic movements	0	1
Asks patient to cough to bring out any hernias	0	1
Palpates all regions lightly whilst looking at patient for signs of pain. Also looks for guarding, rebound tenderness and rigidity	0	1
Palpates deeply for masses and deep tenderness	0	1
Identifies features of masses (site, size, shape, edge, consistency, percussion note, bowel sounds)	0	1
Palpates for liver from right iliac fossa on deep breathing. If enlarged describes edge (up to 2cm is normal)	0	1
Palpates for spleen from right iliac fossa to left hypochondrium	0	1
Ballots kidneys on inspiration	0	1
Percusses for the upper and lower borders of the liver	0	1
Percusses for the spleen asking patient to roll over to percuss behind	0	1
Percusses for suprapubic dullness in bladder distension	0	1
Perscusses for shifting dullness of ascites (waiting 30 seconds after patient rolls over)	0	1
Auscultates for bowel sounds for at least 30 seconds	0	1
Auscultates for renal and aortic bruits	0	1
Thanks patient and offers help to redress	0	1
Washes hands	0	1
Requests full inguinal exam including examination of the external genitalia and urinanalysis	0	1
Summarise appropriately with only key findings.	0	1
Offer appropriate differential diagnoses.	0	1
Patient global score	0	1	2

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