November 19, 2025

PACES diaries

Learning PACES is never easy unless you have someone to pave the pathway for you

Abdominal Examination

The Abdominal examination is not just restricted to the Gastrointestinal system, rather it covers all the quadrants of abdomen. Learn the secrets to score higher in this system.

Enter

Greet the Examiner

Sanitize your hands

Introduce yourself to the examiner

Inspect around for any clues

Approach from the right side and adequately expose the patient take patients permission and adequately expose the patient, up to knees and abdomen, if male possibly bare above the waist

Check for asterixis, clubbing, nail changes, nicotine staining, Dupuytren’s contracture, check for scars, radial artery scars, arts line, run your hands to check for av fistula, if you find a fistula do not forget to palpate and auscultate, you are supposed to comment whether it is being used or not so look for puncture marks. Also check for any tattoo marks. Check the pulse, offer for blood pressure.

Inspect for JVP it can be seen to know about cardiac cirrhosis, restrictive cardiomyopathy associated with liver conditions, volume status in renal failure, also check for puncture marks in neck for any previous central line insertion, also do not forget to check for lymph nodes

Check for pallor, icterus

Check oral cavity, denture, oral hygiene, tongue, ulcers, gum hypertrophy

Check for any gynecomastia, if it is there then examine for it asking permission from the examiners and the patient,

Always start with the inspection Adequately expose the abdomen and inspect all quadrants, check if they are moving symmetrically, notice any distended veins, scars, scars of peritoneal dialysis, check if there is any pyoderma gangrenosum, scars of splenectomy, liver transplant, hernioplasty, check for visible pulsation, distended veins,

Superficial Palpation

Palpate gently and look at the patients face for any grimace to notice any tenderness

Liver: start from right lower quadrant just beyond umbilicus and palpate towards right costal margin advancing with each deep inspiration. Identify where the liver edge is felt, note any tenderness, texture, nodularity etc.

Lif -palpate deep for any masses, transplant kidney

Rif- palpate deep for any masses, transplant kidney

Epigastrium - palpate deep for any masses, gentle if pulsatile

Hypogastrium - palpate for any swellings from pelvis incl bladder

Rt flank; lt flank - check for ballotable swellings

Percuss liver

Percuss for shifting dullness (do not do that in case of very gross ascites, where you can do fluid thrill by asking either patient or examiner to keep ahand)While in the same position palpate for the spleen and percuss it.

Percuss over enlarged Kidneys

Right iliac fossa for bowel sounds, just on either side of midline halfway between umbilicus and xiphisternum for renal bruit. Also, on all masses felt auscultate for vascularity as evidenced by bruit especially liver.

BACK: Then sit the patient up Check for spider angioma in the back of upper trunk, gynecomastia, sacral edema.

LEGS: Finally, both legs for pedal edema.

Concluding: Thank the patient, offering to help dress him up, wash hands and turn to the examiner. Present by saying that you would finish the examination by further checking for hernial orifices, per rectal examination.

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