History Taking & Physical

Examination of Acute Abdomen

1. General Objective

After finishing skill practice of Clinical examination of surgical diseases and disorders of
the abdomen, the student will be able to perform history taking and physical
examination of surgical diseases and disorders of the abdomen correctly.

2. Specific Objective :
At the end of skill practices, the student will be able to perform clinical
examination of acute abdomen correctly.

3. Syllabus Description :
a. Sub Module Objective
After finishing skill practice of examination of acute abdomen, the student
will be able to perform history taking and physical examination of acute
abdomen correctly.
b. Expected Competencies
 Students perform history taking of acute abdomen.
 Students perform physical examination of acute abdomen.
c. Topics
 History taking of acute abdomen
• Greet the patient and confirm identity: train the student to perform the
informed concent, and collecting the patient data.
• Chieft complain: Determine the chief complaint and onset of illness,
train the student to collect data of chief complaint and timeline of the
symptom.
• Other related symptoms: train the student to get other information
related of the symptoms of acute abdomen, train the student to find
differential diagnosis and exclude it.
• Collect the previous history, family history, other significant illness, and
house environment: train the student to find the risk factor of the present
illness.
• Collect the history of current medication: to collect data about present
medication.
 Physical examination of acute abdomen.
• Preparation: train the students to perform informed consent and prepare
the patient for the physical examination.
• Implementation o General examination: train the students to examine
general appearance, vital sign, other system, and ask the patient to
expose his abdomen. o Abdominal examination: train the students to
 performe inspection, auscultation, palpation, and percussion of patient’s
abdomen, and digital rectal examination to get any sign of acute
abdomen.

d. Methods
 Presentation
 Demonstration
 Coaching
 Self practices: role-play

A. Attachment
1. Instrument, substances and material needed
Presentation :
Audiovisual : Slides presentations on LCD projector.
Demonstration and coaching : a.
Table
b. Chairs
c. Examination couch
d. Stethoscope
e. Pelvic model

2. Assessment:
Performance scale 0 = Neither mention nor do the procedure
Performance scale 1 = Only mention the procedure
Performance scale 2 = Mention and do the procedure

3. Speciment Handling
4. Standardized patient& Preparation for the Patient
Adult male (for aloanamnesis), 25-30 y.o, skinny/muscular
5. Venue
Skills Laboratory, C5 building fl.1, Faculty of Medicine Universitas Padjadjaran
6. Reference
7. Resource Department: Department of Surgery, Faculty of Medicine Universitas
Padjadjaran
Learning Guide HTPE Acute Abdomen

Performance
No. Procedure Scale
0 1 2
Introduction

1. Greet the patient, and develop a warm and helpful environment

2. Introduce yourself to the patient
Patient Identity

3. Ask the patient politely concerning his/her name and age

4. Ask the marital status of the patient
Chief complaint

5. Ask the patient regarding why the patient comes to you.

6. Pain:
Onset
Site at onset and site at present
Severity
Aggravating factors and Relieving factors
Duration
Progress
Type of pain
Radiation
Other related symptoms

7. Ask the patient concerning related symptoms of gastro-intestinal

function: Nausea
Vomiting
Loss of appetite & Faintness
Previous indigestion (habitual)

8. Bowel habit:
Constipation?
Diarrhoea?
Colour of the stool?
Presence or absence of blood and mucus (slime)
9. Jaundice
10. Urinary function:amount& color of urine, lower abdominal discomfort.
11. Gynaecological functions:
Menstrual function
Delayed or miss periods
Abnormal bleeding or discharge (colour, quantity)
10. Previous history of :
Previous similar pain
Previous abdominal surgery
Previous major illness: incl. fever, abdominal injury.
Drugs
Allergies

Performance
No. Steps Scales
0 1 2
11. Diagnosis:
Acute appendicitis
Ovarial cyst torsion or rupture
PHYSICAL EXAMINATION
1 Ask the patient politely to expose his abdomen
Abdominal examination
Inspection
2 Inspect the movement: respiratory movement, visible bowel movement
3 Is there any scar on the skin of the abdomen?
4 Is there any abdominal distention? flatus, fluid, fetus.
Is there any rashes/discolourization? Grey turner sign, cullen sign,
5
echimosis of abdominal wall
6 Is there any masses? tumors, hernial site, tumor with pulsation
Auscultation
Using stetoscope, put it gently on the abdomen. listen to the bowel sound
and bruit at least for one minute:
• Absent?
7
• High pitched and hyperactive?
• Metallic sound?
• Vascular bruit?
Palpation
8 Ask the patient to locate the maximum pain with the tip of finger.
Using the palmar surface of your fingers, gentlypalpate the abdomen
9 starting from the farthest site from the maxium pain, move gradually
toward it. And look for any sign of:
10 • muscle guarding/ rigidity
11 • tenderness / rebound tenderness
12 • murphy’s sign, rovsing’s sign
13 • psoas sign, obturator’s sign
14 • masses or swelling
15 • expansile pulsation
Percussion
Place the palmar aspect of your left hand on the abdomen, and gently
16 percuss its dorsal aspect with the tip of the middle finger of the right hand,
moving all around the abdominal region:Listen is there any
17 Tympanic, dull, shifting dullness
18 site of liver dullness, and is it dissapeared?
19 DRE (only talk)