Gynaecological examination

Published on 09/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 09/03/2015

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2 Gynaecological examination

Chapter contents

Abdominal examination

Pelvic examination

Presenting an examination

As with the examination of any organ system, a gynaecological examination starts with a general examination. One should assess from the end of the bed whether the patient appears healthy or not, obese, average or thin, anxious or at ease. One should specifically examine for anaemia, jaundice or lymphadenopathy. If the patient is a young fit woman, then further general examination is unnecessary; however, if the patient is elderly or unwell then a more detailed examination is required. The practice of routine breast examination is controversial, but if it is performed one should initially observe for tethering or peau d’orange. All four breast quadrants are palpated, followed by the axilla on each side with the patient’s arm resting on the examiner’s arm so that there is no tension in the axilla.

Abdominal examination

This commences with inspection, and exposure must be from the symphysis pubis to the xyphisternum, taking care to respect the patient’s dignity with regard to the genital and breast region, with appropriate drapes. It is important to ensure that the patient is lying comfortably and that she has emptied her bladder. On inspection one looks for asymmetry in the abdomen and scars, particularly above the symphysis pubis and in the umbilicus. The distribution of body hair should be noted and any striae or hernias.

Before moving on to palpation one should enquire whether there are any areas of tenderness. One then gently palpates around the abdomen looking for areas of tenderness or masses. If any masses are found, then they should be percussed, remembering that fluid-filled and solid cavities are dull, and free fluid in the abdomen will be percussed as shifting dullness on the change of position.

Auscultation is used to ascertain the nature of bowel sounds if the woman has presented with an acute problem.

Pelvic examination

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