1 of 27

Red Flags on Abdominal Examination�

2 of 27

Red Flags in Abdomen

Shape

    • Distension - Visible Loops/ Surface Veins

Tenderness

Palpable Mass

3 of 27

Red Flags in Abdomen

Umbilical Cord – Abnormalities / Vessels/ inflammation

Hernias - (Umbilical / Inguinal / Diastasis Recti)

Aspirates - (watery / mucoid / yellow / green / black )

4 of 27

Shape of Abdomen

5 of 27

Abdominal Distension

6 of 27

Distension/ Diastasis Rectus Abdominis

7 of 27

Gastric Aspirates

  • Nothing to Do
    • Watery / Mucoid / Light yellow / Light Green
  • Observe
    • Green or dark yellow
  • Immediate Intervention or Surgical Review
    • Dark Green
    • Feces like
    • Dark brown or Red

8 of 27

Umbilical Hernia

  • Common

​

  • Self-Resolving

​

  • If > 2cm, may be associated with complications.
    • Surgical consult

9 of 27

Umbilical Polyp and Granuloma

10 of 27

Umbilical Discharge

  • Faecal
  • Watery (urine)
  • Pus

11 of 27

UMBILICAL VESSELS

12 of 27

Umbilical Cord Infection

  • Pus discharge
  • Redness of skin surrounding umbilical stump >1cm

13 of 27

14 of 27

Inguinal Hernia

15 of 27

Anal and Rectum Examination

The anus should be checked carefully for patency , position and size

The fistula should be examined as fistula is positioned either anterior or posterior to normal anus

16 of 27

Imperforate Anus

17 of 27

18 of 27

19 of 27

Genitalia Examination

20 of 27

When to Suspect Disorders of Sexual Differentiation (DSD)

Seemingly Male

Stretched penile length < 2.5cm.

​

Bilateral undescended testes.

​

Bifid Scrotum.

​

Hypospadias with Unilateral Cryptorchidism.

​

Isolated Peno-scrotal Hypospadias.

​

Clitoromegaly >1 cm

​

Fused Labia

​

Masses in Labia Majora

​

​

​

​

Seemingly Female

21 of 27

Male Genitalia

  • Penis
    • Stretched penile length <2.5cm is abnormal
    • The degree of hypospadias and chordae should be noted

​

  • Scrotum
    • Can be quite large - that’s normal.
    • Trans-illumination test – R/O hydrocele
    • Hyperpigmentation – suspect adrenal problems

​

  • Testes on palpation:
    • Should be of same size
    • Should not be tender or appear blue (torsion)
    • 2% to 5 % of term males will have undescended testes

22 of 27

23 of 27

24 of 27

25 of 27

Female Genitalia

  • Labia majora and minora:
    • Examine for any swellings especially bilateral.
    • Look for Hyperpigmentation.
    • May be red and swollen due to maternal hormones.

​

  • Clitoris
    • The mean clitoral length in term is 4.0mm.
    • Clitoral enlargement (>1cm in length or 0.5cm in width ) – suspect androgen excess

26 of 27

27 of 27