INSTRUCTION: 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 COMFORTABLE 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 FROM THE FOOT END OF BED AND FROM THE RIGHT SIDE OF BED.
TO EXAMINER:
ON GENERAL NSPECTION THIS GENTLEMAN LOOKS WELL AND IS COMFORTABLY LYING ON COUCH WITH NO EVDIENCE OF SYSTEMIC DISEASE AS PALLOR, JAUNDICE, WEIGHT LOSS OR SHORTNESS OF BREATH.
HIS ABDOMEN IS FLAT/SCAPHOID/ROUNDED/PROTUBERANT AND IS MOVING WITH RESPIRATION. THERE IS A SMALL/LARGE LUMP IN THE LEFT LOWER QUADRANT OF THE ABDOMEN WHICH IS ABOUT 12 BY 8 CMS IN SIZE. IT IS ROUNDED IN SHAPE. THERE IS A WIDE, IRREGULAR AND PUCKERED SCAR (INDICATING WOUND INFECTION FOLLOWING PREVIOUS OPERATION) PRESENT IN THE OVERLYING SKIN. THERE IS NO EVIDENCE OF ANY REDNESS, DISCOLOURATION, VISIBLE VEINS, AND PERISTALSIS IN THE OVERLYING SKIN. THE SURROUNDING SKIN IS THIN AND SHOWS EVIDENCE/ NO EVIDENCE OF SCARS OF PREVIOUS DRAIN SITES OR STOMAS. THE UMBILICUS IS CENTRALLY PLACED AND INVERTED.
TO PATIENT:
I AM NOW GOING TO TEST FOR A COUGH IMPULSE. SIR COULD YOU PLEASE TURN YOUR HEAD TO THE OTHER SIDE AND COUGH?
TO EXAMINER:
THE LUMP SHOWS AN EXPANSILE COUGH IMPULSE.
TO PATIENT:
I AM NOW GOING TO FEEL YOUR TUMMY. PLEASE LET ME KNOW IF IT IS TENDER ANYWHERE. I WILL BE VERY GENTLE.
ACT:
KNEEL ON RIGHT SIDE OF PATIENT SO THAT YOUR ARM AND FOREARM ARE AT SAME LEVEL. RUB YOUR HANDS TOGETHER TO MAKE THEM A BIT WARM BEFORE TOUCHING PATIENT. LOOK AT PATIENTS FACE AND START PALPATION FURTHEST AWAY FROM THE LUMP. BEFORE TOUCHING LUMP, CHECK TEMPERATURE AND COMPARE WITH SURROUNDINGS, THEN LIGHTLY PALPATE OVER IT FOR TENDERNESS LOOKING AT PATIENTS FACE.
THEN PALPATE DEEPLY IN ALL QUADRANTS COMING TO THE LUMP.
TO EXAMINER:
THE OVERLYING SKIN IS NOT WARM. IT IS A NON TENDER LUMP WITH SMOOTH SURFACE AND DIFFUSE EDGES. IT IS SOFT/FIRM/DOUGHY IN CONSISTENCY AND IS NON COMPRESSIBLE.
TO PATIENT:
I AM JUST GOING TO TEST FOR A COUGH IMPULE. SIR COULD YOU PLEASE TURN YOUR HEAD TO THE OTHER SIDE AND COUGH?
TO EXAMINER:
THE LUMP HAS AN EXPANSILE COUGH IMPULSE.
TO PATIENT:
I AM JUST GOING TO PINCH THE OVERLYING SKIN.
TO EXAMINER:
THE SKIN IS FREELY MOVEABLE OVER THE LUMP.
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Tags: clinical, hernia, MRCS, mrcs surgery viva, operation, surgery, viva