Last night was the second in my series of lectures of teaching the various elements of clinical examination to the nursing staff.
The topic of last night's meeting was the abdominal examination.
It was necessary to explain that much of what leads to differential diagnosis of abdominal disease is based on the history.
For example, with abdominal pain, was the onset acute or slow onset, the location, the quality, the severity, radiation of the pain, relieving factors, precipitating factors and exacerbating factors, etc... All these elements can be important to give a particular diagnosis more weight than other disease processes.
One of the nurses raised an excellent question with regards to why acute appendicitis typically begins as central abdominal pain and then becomes localised in the right iliac fossa. It was then necessary to explain about the difference of the nerve supply to the bowel compared to that of the abdominal wall and distension of a viscus resulting in poorly localised pain compared to direct stimulation of the parietal peritoneum resulting in localising pain respectively.
In this 2-hour session, it was not possible to cover all the elements of the history and physical examination of the abdomen, but a number of serious conditions and their clinical manifestations were covered e.g. pancreatitis with Cullen's and Grey-Turner's signs, bowel obstruction, acute cholecystitis and so on.
From the photo above, it can be seen that the 'simulated patient' and other nursing staff were asked to perform the clinical examination for encephalopathy, known as hepatic flapping tremor or asterixis.
Thanks to Yuka-san for such great translating to the nursing staff !
Have a good day.... :-)