1. ABDOMEN

2. Examination of the Abdomen  Ensure the patient is lying flat (remove any extra pillows,if present,with the permission of the patient);the hands should lie by his or her side with the abdomen exposed from the inframammary region to just above the genitalia.do not expose the genitalia.  Begin with the hands,looking for the following signs:  Clubbing,leuconychia (white chalky nails).  Palmar erythema.  Duputryens contracture (feel for thickening of the fascia).  Hepatic flap.

3.  Examine the arm:  Look for arteriovenous fistula, hemodialysis catheters,spider naevi.  Comment on the skin :  Pigmentation.  Scratch marks.  Examine the Following :  Supraclavicular and cervical lymph nodes.  Tongue for pallor.  Eyes for anemia,jaundice,xanthelasma.  Upper chest and face for spider naevi.  Axilla for hair loss,acanthosis nigricans.  Breast for Gynaecomastia.

4.  Inspect the abdomen,Looking for the Following signs:  Movements  Any obvious mass  Visible veins (check direction of flow,which is usually away from the umbilicus).  Visible Peristalsis.  Hernial orifices (ask patient to cough at the stage).  Expansile pulsation of aortic aneurysm.  Ask the patient whether the abdomen is sore at any part

5.  Palpation :kneel on the floor or sit on a chair before you begin palpation.at all times look at the patients eyes to check whether he or she winces in pain. Begin with superficial pain and begin in the least tender area.palpate in all the Quadrant's (remember that there are four quadrant's ).  Palpate:  For mass- determine its characteristics.  Liver(percuss for upper border using heavy percussion,for lower border using light percussion).  Kidneys (bimanual palpation,demonstrate ballottement).  Groin for lymph nodes.  Check Hernial Orifices  Test for expansile pulsation of an aortic aneurysm.

6.  Percuss Looking for shifting dullness (at the stage, when patient is lying on his or her right side, seize the opportunity to examine for a small spleen and for pitting edema over the sacral region).Remember that abdominal percussion should follow adequate inspection and percussion.  Auscultate :  Over an enlarged liver for bruit.  Over a suspected aortic aneurysm.  For bowel sounds.  Tell the examiner that you would like to perform a rectal examination and examine the external genitalia.  Examine the legs for edema.

7. THANK YOU DR. Hossam abdalraziq