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Approach

1. Exposure of the abdomen
   • Degree of exposure depends on the case
   • Position the patient flat on the bed, keep groin area covered until later
   • Start by looking for peripheral stimata of gastrointestinal disease
2. Hands
   • Signs of chronic liver disease and IBD
   • Koilonychia (spoon shaped nails in IDA)
   • Pallor of palmar creases in anaemia
   • Check for liver flap (late sign of hepatic encepalopathy)
3. Eyes
   • Anaemia
   • Jaundice
4. Mouth
   • Hepatic fetor
   • Pallor of mucous membranes
5. Neck
   • Palpate for supraclavicular lymphadenopathy - Virchow's node (Troisier's sign) foun din supraclavicular fossa between the sternal and clavicular heads of sternocleidomastoid muscle
6. Trunk
   • Inspect rest of arms and upper chest wall for spider naevi
   • Briefly inspect the back
7. Abdomen
   • Expose down to the pubic symphysis

1. Inspect: stand back from the couch
   • Distension
   • Scars - where there is a scar, look for an incisional hernia
   • Visible pulsation
   • Ask patient to take a deep breath in and hold - seeing transmitted pulsation of AAA
   • Ask patient to cough / lift head off bed to demonstrate herniae
2. Palpate: kneel down to patient's right side
   • Ask if they have any pain anywher before beginning palpation
   • Look at patient's face while attempting to elicit tendeness
   • Begin farthest away and palpate 9 quadrants
   • Check for pulsation in the epigastric region
   • Continue with deep palpation in the 9 quadrants
   • Palpate the liver
   • Palpate the spleen
   • Ballot the kidneys
3. Percuss
   • Spleen and liver
   • Percuss for ascities
4. Ascultate
   • Liver bruit
   • LIF for bowel sounds
   • AAA, iliac vessels for bruit

Continue

1. Expose external genitalia
2. Examine scrotum
3. Examine inguinal canal for herniae
4. Palpate the femoral pulses and check for femoral herniae

Completion

1. Cover patient
2. Review observations - Temp, BP, pulse, RR
3. Examine lower limbs - peripheral oedema
4. Examine external genitalia and groin (if not already done)
5. PR / Digital rectal examintion
6. Dipstick the urine