Introduction (Use the acronym WIPER to prepare for the examination)
- W - Wash your hands
- I - Introduce yourself and confirm patient details
- P - Permission - gain consent to proceed with the examination, including explaining relevant details
- E - Expose the patient appropriately, gather Equipment
- R - Position the patient lying back at 45 degrees comfortably
- Inspect from end of bed
- Look for relevant paraphernalia (e.g. nutritional supplements, CAPD device)
- Inspects patient
- Body habitus
- High BMI
- Cushingoid from immunosuppressants following organ transplant)
- Pallor (anaemia)
- Jaundice
- Pigmentation (Addison’s disease, Peutz–Jeghers syndrome, ‘bronze’/slate grey in haemochromatosis, drugs)
- Bruising
- Tattoos
- Peripheral skin lesions associated with IBD
- Erythema nodosum
- Pyoderma gangrenosum
- Hands
- Clubbing (IBD, malignancy, malabsorption states such as coeliac disease, liver cirrhosis)
- Dupuytren contracture
- Palmar erythema
- Leukonychia (iron deiciency)
- Koilonychia
- Liver lap
- Arms
- Arteriovenous fistula (for dialysis) auscultate for bruit
- Tattoos
- Eyes
- Jaundice
- Anaemia
- Xanthelasmata
- Face
- Parotid enlargement (alcohol excess)
- Mouth
- Angular stomatitis (iron/vitamin B deiciency)
- Glossitis (vitamin B deiciency)
- Peri-oral pigmentation (Peutz–Jeghers syndrome), telangiectasia
- Ulcers (IBD)
- Dehydration
- Dental hygiene
- Smell of breath (hepatic fetor, uraemia)
- Neck
- Supraclavicular lymph nodes (Virchow’s node/
- Troisier’s sign for stomach cancer)
- Chest
- Gynaecomastia
- Liver disease
- Spironolactone (often tender)
- Cimetidine
- Puberty
- Spider naevi (more than ive is signiicant) in distribution of SVC
- Gynaecomastia
- Inspect abdomen
- Scars
- Drain insertion sites
- Peristalsis/pulsations
- Caput medusae
- Distension
- Masses/swellings
- Stretch marks/striae
- Palpates abdomen (ideally kneeling down):
- Superficial palpation in nine quadrants for masses and tenderness
- Deep palpation in nine quadrants for masses and tenderness
- Hepatomegaly
- Splenomegaly
- Ballots kidneys
- Abdominal aortic aneurysm
- Percusses abdomen
- Liver
- Spleen
- Ascites with shifting dullness
- Bladder (dull if full, e.g. in urinary retention)
- Auscultates
- Bowel sounds
- Renal bruits
- Abdominal aortic aneurysm
- Examines for shifting dullness/ascites
- Examines lower legs for oedema
- Examinations: 3 Abdominal 11
- Tells examiner he would like to complete the
examination by examining the following:
- Hernial oriices (with cough/sitting up)
- Genitalia
- Rectum
- Lymph nodes
- Urine dipstick
- Finishing
- Thank patient and offers to help patient get dressed
- Wash hands and think about how to present your findings
- Present Findings and suggest a differential diagnosis
- Suggests appropriate investigations and management