Monday, March 23, 2015

Study group discussion: Correct order of clinical assessment of the abdomen

Question: During clinical examination of abdomen what is the correct sequence of the following events?
Palpation - inspection - auscultation - percussion.

Answer: You first need to auscultate in abdominal examinations because bowel sounds increase after palpation. So it would be inspection -  auscultation -  palpation - percussion.

When assessing most body systems, the appropriate order is inspection, palpation, percussion, and auscultation. However, with the abdominal assessment, auscultate before you manipulate the abdomen with palpation and percussion. The rationale for this is that manipulation of the abdomen with palpation and percussion may stimulate peristalsis and thereby alter your examination findings. So the appropriate order for the abdominal examination is inspection, then auscultation, followed by palpation and percussion.

Research paper: http://www.ncbi.nlm.nih.gov/books/NBK420/

Extra tips: You wanna ask the patient whether it hurts somewhere and palpate that area last.

While examining abdomen always expose the patient from nipples to midthigh. Also one more important thing is that, abdominal examination is never complete without examination of external genitalia.

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