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Hello team and welcome to abdominal bedside teaching. The aim of this video is to provide you with the essential theoretical framework to maximize our practical time at the bedside. We'll cover history taking and the key points of abdominal examination. We will practice the techniques of performing each step in more detail during the session. This video aims to provide you with the theoretical knowledge needed before the bedside session. We'll go through the key points in history taking and a structured approach to the physical examination, ensuring you are well prepared for the hands on practice. First, let's start with our history. When taking a history. You are trying to get a detailed description of the presenting complaint. In addition to that you are scanning for risk factors. Those could be present anywhere throughout the history. From the drug history to the social and occupational history. This information not only helps guide you towards a diagnosis, but it might also provide relevant information that would affect your management plan such as anticoagulants that require reversal. Some general points to remember throughout your history are signposting as well as using ice. Ice stands for ideas, concerns and expectations. Don't underestimate the patient's role and their ideas and perceptions on their presenting symptoms. This information can be very valuable in guiding you throughout your assessment. Here is a suggested structure for history taking. This is not fixed with practice. Changes can be made to suit your style in taking a history. When taking a history. Always start by identifying the presenting complaint. This is what brought the patient into the hospital. We need to focus on one or two main symptoms. Common ones include abdominal pain, constipation, vomiting or pr bleeding. Try to frame your question around what brought you in today. Once you have the presenting complaint delve into it using the Socrates framework. This is especially useful when the complaint is abdominal pain, Socrates stands for site onset character, radiation associated symptoms, timing, exacerbating and relieving factors and severity. Additionally, think about relevant systems when asking about associated symptoms such as the gi and urinary systems to be a safe doctor. Don't forget to screen for systemic symptoms like unintentional weight loss and night sweats, which could indicate malignancy. Here is a list of symptoms within some of the systems. You might find relevant, feel free to pause the video here and have a read through. Do you know what these symptoms mean? Are you able to inquire about those in a patient friendly language? A comprehensive systemic review ensures that we don't miss any associated symptoms. This might look like a long list to cover. However, it should only consist of 2 to 3 questions for each system asked in the form of quick questions. It's important to signpost prior to this section as it might confuse the patient that you're asking about some symptoms that might seem irrelevant with practice, you will develop your own style of covering the systemic review. Remember, you have already covered relevant systems in detail during the history of presenting complaint, it's crucial to explore the patient's past medical and surgical history, including any hospital admissions, specifically. Inquire about past abdominal surgeries as these may lead to lesions or incisional hernias. Ask about any significant illnesses, ongoing conditions or recent treatments or procedures. Next review, the patient's drug history including any current medications, allergies and past treatments. Remember to ask about newly started medications as well and how those might correlate with the presenting symptoms. Here are some medications that could be particularly important depending on the presenting complaint. Try to think of conditions that could be related to each of those medications or ways in which they could alter your management. I'll be waiting to hear your thoughts during our session. Family history can reveal hereditary conditions like Lynch syndrome or Pots Jer syndrome, which might raise suspicion for certain gi cancers. If there is a family history of a condition, follow that up with a question about the age of onset and outcome. Please note that this might bring up some difficult memories for patients in the case of the suffering or death of a relative. It is important to be as human as possible during such instances and show empathy. Otherwise, a robot can do your job moving on to the travel history within the context of an abdominal presentation. It is particularly relevant for identifying infectious conditions such as travelers, diarrhea, or hepatitis. A social and occupational history is equally important. Ask about smoking, alcohol consumption and any recreational drug use, especially intravenous injections. Can you think of medical conditions which relate to the consumption of any of those substances? I want you to also think how a patients occupational history caused them to present with symptoms such as abdominal pain. Let's move on to the second part of this video. I will take you through the steps of performing an abdominal examination before you start your examination. Take a moment to inspect the patient's general condition. Are they in distress in pain or confused? Look around the bedside for medical equipment like catheters or IV lines which may provide clues about the patient's ongoing medical conditions. Observing the surroundings can give you important context before diving into the examination. This slide demonstrates a visual guide to the order of areas covered during a full abdominal examination. Pause here to familiarize yourself with those steps during general inspection. Observe the patient for any signs of pallor jaundice or hypopigmentation, visible scars, stomas or surgical drains are also important to note. Does the patient appear cachectic or are there visible lumps. These observations provide valuable insights into what you may encounter in the next steps of the examination, performing the step from end of the bed, gives you a better view of the patient. Next. Move on to inspecting the hands and arms when inspecting the hands, look for palmar, erythema, leuconychia, koilonychia, or signs of clubbing, all of which can point to systemic conditions. Don't forget to check for asterixis also called flapping tremor if present. Do you know what it could indicate? Checking the temperature, CRT and pulses aid in assessing the patient's hemodynamic stability. Quick note for you here regarding technique. Remember to use the dorsum of your hand when assessing temperature and comparing both sides to detect any changes in the arms. You might see excoriations which are signs of scratching likely due to pruritus. Why might this be relevant for our abdominal examination when inspecting the axilla? Look for signs like acanthosis Nigro cans which could indicate insulin resistance or rarely an internal malignancy moving on to the face, check the eyes for jaundice, conjunctival, pallor corneal arcus or xantho asthma. Don't miss out on less common findings such as Kaiser Fleischer Rings. What do those indicate, examine the neck for, raise jugular venous pressure, JVP, palpate for lymphadenopathy in the supraclavicular region? Here are some questions for you. Do you know what Virchow's note is? Have you heard of Choi's sign if yes, do you know what those indicate on the chest look for spider kniv gynecomastia or hair loss, which can be signs of chronic liver disease. What's the definition of gynecomastia? Can you think of some medications that could cause it? Next, you will examine the abdomen. This involves multiple steps. Let's walk through each step together. When describing findings during any of the steps of the abdominal examination. It is important to be able to describe your findings in terms of location. You can follow the nine regions or four quadrant system. This is also very helpful when categorizing your differential diagnosis, consider which organs are located in each area and the symptoms that could arise if there is a disease affecting that region, first start by inspecting the abdomen, look for scars, distension or the presence of striae or distended veins such as caput medusa, check for any hernias or signs of retroperitoneal hemorrhage such as colons or gray turner's signs. Palpation is a critical part of the abdominal exam start with light palpation, asking the patient to report any tenderness while systematically covering all nine abdominal regions, then move to deep palpation, covering the same areas, feel for any masses or organomegaly or areas of tenderness. Note, if there is guarding or rebound tenderness, which can suggest peritoneal irritation. Some descriptions for your findings during this step include soft, rigid peritonitic tender, voluntary or involuntary guarding. The technique of light palpation differs from deep palpation. There are also specific techniques for organ palpation we will discuss and practice those during our session. Some elicited signs are used to check for specific pathologies such as Robing sign and Murphy's sign. Do you know what those indicate? These signs are typically part of a clinical examination but are most valuable when combined with other findings, percussion helps assess the size and density of organs start by percussing all abdominal areas to note variations in dullness or resonance between different regions. What does percussing the abdomen normally sound like? I want you to think of an extra examination to perform during this stage. If you are suspecting acetes, auscultation follows percussion and involves listening for bowel sounds and bruit bowel sounds can be high pitched, frequent and often tinkling or musical sounds which is typical of small bowel obstruction in large bowel obstruction, bowel sounds are generally lower pitched and less frequent bowel sounds can be absent in cases of paralytic ileus. When assessing vessels during auscultation, bruise could be detected which sound like a whooshing caused by turbulent blood flow within an artery. Can you think of some of the causes of bruise finish by inspecting the legs for hair loss or swelling, palpate for pitting edema, which could be indicative of liver failure. What differentiates lower limb edema in cases of liver failure or heart failure from other local causes such as cellulitis or DVT. Further examinations can be performed to complete your assessment. Those include examining the hernial orifices, a digital rectal examination and examination of external genitalia to conclude the examination, cover the patient and thank them for their time. Summarize your findings and discuss how these align with the patient's history and symptoms. This is an important step in synthesizing the clinical picture and forming a differential diagnosis as well as a management plan. This brings us to the end of this video. Thank you for watching. I hope it has given you a refresher of your history and abdominal examination and you feel better prepared for your upcoming session. Take note of any questions you have for us to discuss during the session. See you next time, list of references.