Abdominal system examination
General Examination:
– Is child well nourished?
Plot Wt, Ht, HC
– Is child well/ ill looking?
– Jaundiced/ Pale?
– Dysmorphism/ malformations?
– Peripheral edema (kwashiorkor)
– Rashes (Dermatitis Herpetiformis)
– Mouth- ulcers, cheilosis
– Clubbing of fingers?
– Lymphadenopathy?
– Tongue & palate movements
Chronic Liver Disease signs:
– Jaundice
– Encephalopathy
– Muscle wasting
– Palmar erythema
– Leukonychia
– Asterixis
– Strawberry angiomas
– Caput medusae
– Gynecomastia
– Oedema of feet
Inspection of abdomen:
Ensure good exposure to inspect
– Any distention of abdomen?
– Lax belly in Coeliac
– Visible peristalsis (Pyloric stenosis)
– Abnormal skin / discolouration?
– Distended veins?
– Any scars of bowel surgery?
– Gastrostomy present? Any inflammation?
– Inspect hernial sites & perineum
Percussion of abdomen
– Normal?
– Tympanic (bowel obstruction)?
– Dull (in ascites)?
Shifting dullness?
Peritonitis signs?
Auscultation:
Listen for bowel sounds
– Present as normal?
– Hyper-peristalsis (bowel obstruction)?
– Absent (ileus)?
Any bruits over liver, kidneys?
Palpation:
Superficial & deep in all quadrants
– Peritonitis signs:
Tenderness/ Guarding / rebound?
McBurny point (appendicitis)
Murphy’s sign (gall bladder)
– Liver palpable?
smooth/ firm
regular/ irregular
– Spleen palpable?
– Kidneys – bimanual palpation?
– Any other mass?
– Palpate inguinal areas- hernia/ LN?
– Scrotal exam in boys
Testicular mass/ tortion
– Anus- position, tags, warts
– Perianal rashes
– Consider PR examination