1. M K ALAM

2.  Abdomen extends from the nipple level to the bottom of the pelvis  Exposure: nipples to knees (ideal)  Patient lying flat on a pillow  Arms by the side ( not under the head!)  Sit or kneel beside the patient  Adequate light

5.  Asymmetry (from the foot end of the bed)  Movement with breathing  Scar, sinus, wound  Prominent veins  Shape of the umbilicus  Cough impulse ( groin, umbilicus, scar)

6.  Gentle palpation: for tenderness start away from the area of pain  Deep palpation: for tenderness  Guarding: muscle contracted overlying the tender area  Rebound tenderness: sudden release causes sharp pain  Organomegaly: liver, spleen, kidneys  Other masses  Cough impulse

9. Percussion  Organs and masses  Liver span  Ascites: fluid thrill, shifting dullness Auscultation  Bowel sounds: normal, increased, absent  Bruit  Succussion splash

10.  External genitalia  Rectal examination: left lateral position, hip flexed to 90º and knee flexed to less than 90° Inspection Palpation

11. CLINICAL DIAGNOSIS INVESTIGATIONS FINAL DIAGNOSIS TREATMENT