Abdominal Examination Routine — DCE Clinical Case

Clinical Case — Station 3 Abdominal Examination

Patient brief (for the candidate)

Mrs Patricia H is a 54-year-old woman. She is known to the gastroenterology service. The examiner asks you to examine her abdomen. ^[1]

The examination (candidate performs the twelve-step routine)

The candidate introduces themselves, positions the patient, and performs the systematic head-to-toe routine: ^[1]

End of bed. The patient is cachectic, with obvious yellow discolouration of the sclera. She is comfortable at rest. ^[1]

Hands. Finger clubbing is present (Schamroth window lost). Palmar erythema of the thenar and hypothenar eminences. Leuconychia. No Dupuytren contracture. No asterixis. ^[1]

Arms. Multiple linear excoriations on the extensor surfaces (pruritus). Several bruises on the forearms. No needle-track marks. ^[1]

Face. Scleral icterus. Periorbital xanthelasma (yellow lipid deposits on the eyelids). Oral cavity: angular cheilitis, smooth atrophic tongue (glossitis from B12 and iron deficiency). No mucosal telangiectasia. No pigmented lip macules. ^[1]

Neck. No Virchow node. No cervical lymphadenopathy. ^[1]

Chest. More than ten spider naevi in the SVC distribution (face, neck, upper chest, shoulders) — confirmed by blanching with a glass slide. Gynaecomastia. Loss of axillary hair. ^[1]

Inspection. The abdomen is distended with the flanks filled and an everted umbilicus. There are dilated radiating veins around the umbilicus (caput medusae). No surgical scars. No visible peristalsis. No stoma. ^[1]

Auscultation (before palpation). Bowel sounds present and normal in all four quadrants. No bruit. No succession splash. ^[1]