Chapter 63 History and Examination of the Abdomen

Abdominal symptoms are a frequent cause for surgical consultation. The underlying cause may be acute, presenting with the euphemistically termed ‘acute abdomen’; subacute, indicating an evolving disorder; or longstanding, suggesting a functional or degenerative condition. The advent of telemedicine and online remote consultation does not alter the basic art and science of consultation; however, the inability to perform a ‘physical’ examination may hamper arrival at a proper diagnosis. The patient must be allowed to explain the presenting complaint without interruption, after which carefully directed questions are used to further refine the history. The past history is important because it may have a bearing on the diagnosis and management. Some drugs will have an effect on the symptoms and signs or may have to be discontinued before surgery. The use of alcohol and illicit drugs, smoking and occupation are important.

Multiple Choice Questions
Weblinks

Journal article

https://pmj.bmj.com/content/95/1130/664/ (paid)

Clinical excellence (a sincere history taking and proper examination of the patient) is the foundation of modern clinical practice. This Oslerian virtue has been taught to generations of medical students since Sir William Osler took the medical teaching from lecture halls to the patient’s bedside.

Book

https://global.oup.com/academic/product/copes-early-diagnosis-of-the-acute-abdomen-9780199730452?cc=gb&lang=en&/

Revered by generations of surgeons, this is a must-read book on the often difficult topic of the acute abdomen, which emphasises meticulous clinical evaluation supplemented by appropriate investigations.

Video

https://www.youtube.com/watch?v=gRWSyqatWQQ

Practical video demonstration of abdominal examination preceded by general examination of a patient’s abdomen.

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