84298 - Semeiotics of the Abdomen

Learning outcomes

Describe the basic elements of the physical examination and instrument-assisted evaluation, and recognize normal results.

Course contents

The course combines theoretical knowledge and practical approaches, with the aim of equipping students with the tools necessary to collect, organize, and interpret clinical data relevant to abdominal conditions.

The course includes the following topics:

1. Clinical reasoning and semiotic method

• Definition and purpose of clinical semiotics

• Hypothetico-deductive reasoning in medical diagnosis

• Distinction between signs (objective findings) and symptoms (subjective experiences)

• Role of clinical experience and physiopathological knowledge in guiding diagnostic hypotheses

• Introduction to patient-centered and clinician-centered interviewing techniques

2. Medical history taking

• Components of a complete medical history:

  • Chief complaint (CC)

  • History of present illness (HPI), with OPQRST-A method (Onset, Prior/Progression, Quality, Radiation, Scale, Timing, Associated symptoms)

  • Past medical history (PMH)

  • Past surgical history (PSH)

  • Medication history

  • Allergies (drugs, food, latex, etc.)

  • Family history

  • Social history

  • Review of systems (ROS)

• Open-ended vs closed-ended questions

• Techniques to improve interview quality: active listening, guided questioning, echoing, clarification, reassurance

• Managing sensitive topics and visitors during the clinical interview

• Cultural and interpersonal aspects of doctor-patient communication

• The role of summarization and structured data collection

3. Abdominal physical examination

• General observation before abdominal assessment: general condition, posture, skin color, signs of systemic illness

• Inspection:

  • Abdominal distension and its causes (e.g., ascites, organomegaly, hernias)

  • Surgical scars and their interpretation

  • Superficial venous patterns (porto-caval and cavo-caval circulation)

• Auscultation:

  • Normal and abnormal bowel sounds (e.g., borborygmi, high-pitched sounds in mechanical obstruction)

  • Vascular bruits (e.g., over the aorta or renal arteries)

• Percussion:

  • Differentiation between tympanic and dull sounds

  • Liver dullness and splenic area percussion

  • Giordano’s sign (costovertebral angle tenderness)

• Palpation:

  • Light and deep palpation techniques

  • Identification of abdominal tenderness, guarding, rigidity

  • Palpation of the liver edge and possible organomegaly

  • Key anatomical points: Murphy's point (gallbladder), McBurney’s and Lanz points (appendix), ureteral points

4. Semiotics of abdominal and urinary symptoms

• Abdominal pain:

  • Visceral vs somatic pain

  • Colicky vs continuous pain

  • Localization and radiation

• Nausea and vomiting:

  • Relation to digestive or systemic causes

• Changes in bowel habits:

  • Diarrhea, constipation

  • Differentiation between ileus and constipation

• Ileus:

  • Paralytic vs mechanical ileus: causes, symptoms, physical signs

  • Characteristics of bowel sounds

• Bowel obstruction and perforation:

  • Symptom progression according to obstruction level (proximal, distal, medium)

  • Signs of perforation and peritonitis

• Jaundice:

  • Pathophysiological classification:

    • Pre-hepatic (e.g., hemolysis)

    • Hepatic (e.g., hepatitis, cirrhosis)

    • Post-hepatic (e.g., bile duct obstruction)

  • Distinction between unconjugated and conjugated bilirubin

  • Associated signs and symptoms: dark urine, pale stools, pruritus, weight loss, acholic stools, hepatic encephalopathy

  • Differential diagnosis: gallstones vs tumors (painful vs painless jaundice)

• Urinary symptoms:

  • Alterations in volume: polyuria, oliguria, anuria

  • Alterations in color: hematuria, hemoglobinuria, bilirubinuria (tea-colored urine), urobilinogen-related orange urine, “purple bag syndrome”

  • Alterations in urination:

    • Dysuria, stranguria

    • Nocturia, pollakiuria

    • Urinary incontinence: types and basic causes

    • Urinary retention vs anuria: differential diagnosis, physical examination, use of bladder ultrasound

Readings/Bibliography

Bates' Guide to Physical Examination and History Taking 12th Edition (available either as printed copy or as ebook format)

Teaching methods

Lessons

Assessment methods

The exam for Semiotics of the Abdomen consists of an oral examination aimed at assessing the student’s ability to understand and apply the key concepts of clinical semiotics related to abdominal signs and symptoms.

The final mark for this module will be expressed in thirtieths (up to 30 cum laude). This grade contributes to the overall grade of the integrated course, which also includes assessments in the following modules:

• Biochemistry

• Anatomy

• Physiology

• Semiotics of the Abdomen

The final grade for the integrated course is calculated as a weighted average of the individual module grades, according to the respective ECTS credits.

Evaluation criteria for the Semiotics module:

During the oral exam, students will be assessed based on:

• Knowledge and understanding of abdominal signs and symptoms, their physiopathological basis, and their clinical relevance

• Ability to organize and communicate clinical information in a clear, structured, and concise manner

• Correct use of medical terminology, particularly when describing signs, symptoms, and physical examination findings

• Ability to apply the semiotic method, including the recognition, classification, and interpretation of symptoms and signs related to abdominal conditions

• Basic clinical reasoning, understood as the ability to logically connect the collected data (from history and examination) to describe plausible clinical scenarios — without requiring formal diagnostic formulations

Teaching tools

PPT slides

Office hours

See the website of Francesco Tovoli