FFinalistSouthampton · 2027
Examinations

CPSA · Clinical examination · Gastrointestinal

Abdominal examination

Inspect → palpate (light then deep) → the organs → percuss → auscultate. Southampton flags this as a common weak point — drill the organ palpation technique until fluent.

Practise it out loud

Position: Patient flat (one pillow), arms by sides, abdomen exposed xiphisternum to pubic symphysis.

The routine

General inspection
  1. 1At rest: cachexia, jaundice, distension, discomfort
  2. 2Around the bed: stoma bags, drains, catheter, nutritional supplements
Hands & arms
  1. 1Clubbing, leuconychia, koilonychia, palmar erythema, Dupuytren’s, liver flap (asterixis)
  2. 2Bruising/excoriations; check for an AV fistula (dialysis)
Face & neck
  1. 1Eyes: jaundice (sclera), conjunctival pallor, xanthelasma, Kayser-Fleischer rings
  2. 2Mouth: ulcers, angular stomatitis, glossitis, hydration
  3. 3Palpate for Virchow’s node (left supraclavicular — gastric malignancy)
Abdomen — inspect & palpate
  1. 1Inspect: scars, distension, striae, caput medusae, visible masses/peristalsis; ask about pain first
  2. 2Light palpation (all 9 regions) — tenderness, guarding, rebound
  3. 3Deep palpation — masses; then the organs
Organs
  1. 1Liver — palpate from the RIF up towards the costal margin on inspiration
  2. 2Spleen — from RIF towards left costal margin (roll to right side if not felt)
  3. 3Kidneys — ballot bimanually
  4. 4Palpate the aorta (expansile = AAA); percuss for shifting dullness (ascites)
Auscultate
  1. 1Bowel sounds (absent = ileus/peritonitis; tinkling = obstruction)
  2. 2Bruits — aortic and renal

Signs & what they mean

Jaundice, ascites, spider naevi, gynaecomastia, caput medusae, liver flapChronic liver disease / portal hypertension
Massive splenomegaly (crosses midline, notch, can’t get above it)Myelofibrosis / CML / malaria
Ballotable bilateral flank massesPolycystic kidney disease
Expansile pulsatile central massAbdominal aortic aneurysm
Rigid abdomen, absent bowel sounds, rebound tendernessPeritonitis
Right supraclavicular / Virchow’s node, cachexia, epigastric massGastric malignancy

To complete, I would…

  • Examine the hernial orifices, external genitalia and perform a DRE
  • Dip the urine; check observations
  • Review the drug chart and relevant bloods (LFTs, FBC)

OSCE tips

  • Palpate the liver and spleen from the RIF upwards on inspiration — starting too high misses a big organ.
  • Distinguish spleen from kidney: spleen has a notch, moves with respiration, you can’t get above it, and is dull to percussion.
  • Always ask about pain and watch the face while palpating.
Full step-by-step walkthrough Geeky Medics