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Practical # 01
Examination of Abdomen
POSITION OF THE PATIENT
The patient should lie flat, with one pillow under the head. in order to relax the muscles of abdominal wall. EXPOSURE Abdomen should be exposed from xiphisternum to the pubis. leaving the chest and legs suitably covered.
1) INSPECTION
Shape of abdomen Normally full Scaphoid: a sunken abdomen due to starvation or wasting diseases. Protuberant: due to fat (gross obesity), fetus (pregnancy), flatuš (gaseous distension due to intestinal obstruction), fluid (ascites). Symmetry Normally symmetrical. Asymmetry may be due to visible buige as a result of gross enlargement of liver, spleen, kidney or large tumors. Bulging may be central arising from the pelvis due to enlargement of uterus, ovary or bladder.
INSPECTION OF NORMAL ABDOMEN
On inspection abdomen is normally full. symmetrical, moving equally with respiration. Umbilicus is central and inverted. There is no scar, striae, pigmentation, prominent veins pulsations or peristalsis. Hernial orifices are intact.
2) PALPATION
General principles Ensure that the examining hands are warm. If patient is in a low bed, sit on, or kneel bedside the bed. Ask the patient if any particular area is tender and examine this area last. Encourage the patient to breathe gently through the mouth. If necessary, ask the patient to bend the knees to relax the abdominal wall muscles. Palpation can be divided into three phases: light, deep and during respiration.
Light palpation
Object To note tenderness, guarding, rigidity and lump. Method Place the examining hand on the abdomen and thereafter maintain continuous contact with the patient’s abdominal wall.
Causes of tender hepatomegaly are hepatitis, liver abscess and congestion due to right heart failure. Confirmation that the palpable mass is liver The mass is in the region of direction of enlargement of liver. Mass is moving with respiration. There is no gap between mass and costal margin and therefore finger can not be inserted between mass and the costal margin. Percussion note is dull over the mass. Palpation of Spleen Place the examining hand on the anterior abdominal wall with the fingertips well below the left costal margin, pressing inwards and upwards. Ask the patient to take deep breath, if spleen is enlarged it will hit the fingers during inspiration. If the spleen is not palpable, the patient must be rolled on the right side towards the examiner with left hip and knee flexed and palpation is repeated with the right hand while the left hand of examiner compressing left lower costal margin downwards. If spleen is still not palpable examine the patient from the left side, curling the fingers of the examining hand under the left costal margin as the patient breathes in deeply. Confirmation that the palpable mass is spleen The mass is in the region of direction of enlargement of spleen.
Mass is moving with respiration. There is no gap between mass and costal margin and therefore finger can not be inserted between mass and the costal margin. Percussion note is dull over the mass. Palpation of Kidney Use a bimanual technique to pal kidneys. Place one hand posteriorly below the cage and the other over the upper anteriorly. Push the both hands together firmly the lower pole moving down between the patient breathes in deeply. Push kidney back and forwards bet two hands- this is known as balloting Assess the size, surface, and consistent palpable kidney. Examine the left kidney Features that confirm that the palpable mass is the kidney not the spleen There is a gap between mass and the costal margin. Fingers can be inserted between mass and costal margin. Mass can be palpable bimanually. Percussion note is resonant over the mass.
3) PERCUSSION
Object To differentiate between abdominal ds due to ascites, gas, or cystic or solid tumor To define the size and nature of organ masses General principles Percuss from resonant to dull area.
Practical # 02
History Taking Steps
History taking is a structured way doctors gather information from a patient to understand their condition. The steps are usually done in a logical order:
1. Identification (Patient
Profile)
Basic details: Name: __________ Age: ____________ Gender: _____________ Occupation: _____________ Address: ___________ This helps give context (e.g., age-related diseases, occupational risks).
2. Chief Compliant (CC)
The main problem(s) the patient is experiencing Written in the patient’s own words Include duration Example: “Chest pain for 2 hours”
3. History of Present Illness
(HPI)
This is the most important part—explore the chief complaint in detail. Common structure (you might hear SOCRATES for symptoms like pain): S ite – Where is it? O nset – Sudden or gradual? C haracter – What does it feel like? R adiation – Does it spread? A ssociated symptoms – Anything else with it? T iming – Constant or intermittent? E xacerbating/Relieving factors – What makes it better/worse? S everity – Pain scale (1–10)
4. Past Medical History
(PMH)
Previous illnesses (e.g., diabetes, hypertension) Past hospitalizations or surgeries
General (fever, weight loss) Cardiovascular Respiratory Gastrointestinal Neurological Genitourinary, etc.
9. Summary of History
Brief recap of key findings Helps confirm understanding before moving to examination
10. Patient’s Ideas, Concerns,
and Expectations (ICE)
What the patient thinks is wrong What they are worried about What they expect from treatment
