Abdominal swelling and abnormal liver tests
AMC Clinical practice station
Examination · 2 min to read · 8 min to perform
Examine his abdomen and talk aloud as you go, so that the examiner knows what you are doing and what you find.
Barry NolanMorning doctor. My belly has got big and my doctor said I should see you.
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Open the full station (charts, voice, result letter) →The task
You are a doctor in a hospital outpatient clinic. Mr Barry Nolan, aged 55, has been referred because of abnormal liver blood tests and increasing abdominal swelling over two months. He is alone. Examine his abdomen and talk aloud as you go, so that the examiner knows what you are doing and what you find. Wash your hands and assume that he is appropriately exposed. At the end, summarise your findings, give your most likely diagnosis and name two investigations. The examiner will give you any findings you ask for.
What this station tests
- Examine in a fixed sequence and say the findings aloud: inspection, palpation, percussion, auscultation.
- Palpate gently first and watch the patient's face; start from the right iliac fossa when feeling for an enlarged liver or spleen.
- Shifting dullness and a flapping tremor are quick tests that change the diagnosis.
- A diagnostic ascitic tap is needed in new ascites to exclude infection.
- Discuss alcohol use without blame, plan supervised withdrawal, and give clear warning signs of bleeding and confusion.
Sources for the clinical content
- healthdirect: Cirrhosis of the liver
- Guidelines for the Treatment of Alcohol Problems (Australia)
- Triple Zero emergency call information (000)
- Medical Board of Australia: Good medical practice, a code of conduct for doctors in Australia
An original practice scenario with invented patients. Not an exam question.