Checklist

WIPER

Physiological parameters

• Check peripheries for stigmata of abdominal disease.

Inspection

• Skin: scars, stomas, sinuses/fistulas, distended veins, drains

Ask patient to cough. Observe for pain, peritoneal irritation, hernias or musculoskeletal pain.

• Abdominal wall: hernias (cough + head-up + heels off bed): inspect ventral abdominal wall, umbilicus, groins and scars

• Abdominal cavity: distension, pulsations, masses, visible peristalsis

• Flanks: scars, flank bulges

Ask patient to lean forward. Inspect for hernias as patient strains.

• Back: scars, sacral oedema, pressure ulceration

• Ankles: peripheral oedema, calf swelling

Palpation

Kneel and look at patient's face to identify discomfort during palpation

• Light palpation, four quadrants: identify peritonitis, distension, musculoskeletal pain (use four fingers of one hand).

• Deep palpation, nine regions: identify masses, organomegaly, rebound tendernes , guarding (use two hands).

• Liver, gallbladder and spleen → on inspiration

• Kidneys → ballot with two hands

• Aorta → lateral to medial palpation with two hands

• Scars: incisional hernias → cough

• Groins: inguinal and femoral hernias, inguinal lymph nodes → cough

• Scrotum

• Lower ribs and pelvis

• Specific abdominal signs (see table on pages 49 – 50)

Percussion

• Percussion tenderness: peritoneal irritation

• Ascites: dullness in flanks, shifting dullness, fluid thrill

• Liver size, spleen size

• Palpable bladder

Auscultation

• Bowel sounds

• Abdominal aortic aneurysm bruit

• Renal artery stenosis bruit

• Liver/splenic bruits

To complete the examination…

• Digital rectal examination

• External genitalia

• Urine dipstick