CLINICAL EXAMINATION OF ABDOMINAL AORTIC ANEURYSM
Author: admin // Category: Clinical Skills, MRCSINSTRUCTION: EXAMINE THIS GENTLEMANS ABDOMEN.
TO PATIENT:
HELLO MR.SAM. MY NAME IS DR. NAZISH GHAZANFAR. HOW ARE YOU FEELING TODAY? REPLY ACCORDINGLY.
MAY I PLEASE EXAMINE YOUR TUMMY? THANK YOU.
LET ME JUST DRAW THE CURTAINS TO ENSURE PRIVACY. I HAVE ALREADY WASHED MY HANDS.
COULD YOU PLEASE LIE DOWN FLAT ON THIS COUCH WITH MAXIMUM ONE PILLOW BEHIND YOUR HEAD, WITH YOUR ARMS BY YOUR SIDE AND YOUR LEGS UNCROSSED TO RELAX YOUR ABDOMINAL MUSCLES? CAN I PLEASE EXPOSE YOU FROM YOUR LOWER CHEST TO GROIN.I WILL COVER YOUR PRIVATE PARTS SIR.
ARE YOU CONFORTABLE SIR?
DO YOU MIND IF I TALK ABOUT YOU TO THE EXAMINERS AS I GO ALONG?
I AM JUST GOING TO HAVE A LOOK FIRST OF ALL.
ACT:
STAND BACK AND LOOK GENERALLY AT THE PATIENT AND AT THE ABDOMEN.
TO EXAMINER:
ON GENERAL INSPECTON THIS MIDDLE AGED OR ELDERLY GENTLEMAN LOOKS COMFORTABLE AT REST. HE DOES NOT LOOK SHOCKED, PALE OR IN PAIN AND IS NOT BREATHLESS. THERE IS NO XANTHOMA AND NEITHER IS THERE ANY SWELLING OR FULLNESS IN THE LEFT SUPRACLAVICULAR FOSSA.
NOTE:
KEEP IN MIND THAT BREAST, STOMACH, PANCREAS AND COLON CANCERS CAUSE LEFT SUPRACLAVICULAR LYMPHADENOPATHY.
TO EXAMINER:
ON INSPECTION OF ABDOMEN, THE ABDOMEN IS PROTUBERANT/ROUNDED /FLAT/SHALLOW AND MOVING WITH RESPIRATION.THERE IS FULLNESS IN THELOWER EPIGASTRIC REGION JUST ABOVE UMBILICUS.PULSATION IS VISIBLE OVER THE FULLNESS. THE OVERLYING SKIN SHOWS NO EVIDENCE OF ANY REDNESS, DISCOLOURATION, PIGMENTATION, SCARS OR VSIBLE VEINS AND THE SURROUNDING SKIN APPEARS TO BE NORMAL WITH NO EVIDENCE OF ANY PERISTALSIS OR LAPROTOMY SCARS.
TO PATIENT:
SIR, CAN YOU PLEASE TURN YOUR HEAD TO OTHER SIDE AND COUGH. KEEP ON LOOKING AT THE FULLNESS IN ABDOMEN. THANK YOU.
TO EXAMINER:
COUGH IMPULSE IS NOT PRESENT.
TO PATIENT:
NOW SIR I AM JUST GOING TO FEEL YOUR TUMMY. DOES IT HURT AT ALL? I WILL BE VERY GENTLE.
ACT:
KNEEL ON RIGHT SIDE OF PATIENTS COUCH, YOUR FOREARM AND HAND SHOULD BE AT SAME LEVEL.RUB YOUR HANDS TOGETHER TO MAKE THEM A BIT WARM AND LOOK AT PATIENTS FACE.
LIGHT PALPATION OF ALL 9 AREAS LASTLY FEELING THE AREA OF FULLNESS……FOR TENDERNESS.
DEEP PALPATION OF ALL 9 AREAS OF ABDOMEN LASTLY FEELING THE AREA OF FULLNESS FOR SPECIFIC FEATURES.
FOR CHECKING DIAMETER OF AORTA LOOK IN NORMAN BROWSE BOOK OR BARBARA BATES CD.
TO EXAMINER:
I CAN FEEL A PUSATILE, NON TENDER MASS IN THE EPIGASTRIUM. PULSATIONS ARE EXPANSILE. IT HAS A TRANSVERSE DIAMETER OF 5 CMS. I CAN FEEL UPPER LIMIT WHICH SUGGESTS IT IS INFR RENAL. I CANNOT FEEL A BILOBED STRUCTURE BELOW UMBILICUS WHICH MEANS IT IS NOT EXTENDING INTO ILIACS.
NOTE:
SWELLIN IN FRONT OF AORTA GIVES TRANSMITTED PULSATIONS WHILE A TRULY AORTIC PULSATION IS EXPANSILE.
TO CHECK THIS ASK PATIENT TO TURN TO THEIR LEFT LATERAL SIDE AND FEEL IN THE EPIGASTRIUM WITH PALM OF FINGERS AND WITH THE OTHER HAND SUPPORT PATIENT FROM BEHIND. SWELLING IN FRONT OF ABDOMINAL AORTA WILL BE SEPARATED FROM AORTA AND WILL BECOME NON PULSATILE WHILE AN ANEURYSM WILL CONTINUE TO PULSATE.
TO PATIENT:
CAN I PLEASE FEEL IN YOUR GROINS? MENTION ANATOMICAL LANDMARKS.
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Tags: abdominal aortic, aortic aneurysm, clinical, MRCS, mrcs surgery viva, part 3 mrcs, part B MRCS, procedures, skills, surgery, swelling, vascular, vascular surgery, viva