A strong abdominal exam is a must-have clinical skill for an aspiring healthcare professional.  Diagnoses spanning cirrhosis, appendicitis, hernias, peritonitis, aortic aneurysms, and cholecystitis, for example, can be suspected and even made via abdominal exam.

Unfortunately, secondary to factors which include an increasing dependence on imaging and other diagnostics, time constraints in the practice of medicine, and fewer chances for bedside instruction in medical education with work-hour regulations, physicians rely increasingly less on their physical exam skills today than has been the case in the past.

In that manner, here we review the Answers in Abdominal Examination App, released in May 2011 by Answers in Medicine.  Answers in Medicine, which specializes in presenting medical content via short modules in audio or video format for healthcare professionals, has developed a number of medical apps, including Answers in Alcoholic Liver Disease, Answers in Ulcerative Colitis, Answers in Crohn’s Disease, Answers in Irritable Bowel Syndrome, and Answers in Dyspepsia, to name several.

As you may surmise, Answers in Medicine represents a prolific developer of Gastroenterology- and Hepatology-related content, and boasts an impressive collection of contributors from major academic medical centers in the United Kingdom.  This app, in particular, was created by Owen Epstein, Professor of Gastroenterology at the Royal Free Hospital in London.

Read below the jump to learn more about how the Answers in Abdominal Examination app can help you master the abdominal history and physical exam.

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The Answers in Abdominal Examination app start screen features quick links to info (top-right corner), History Taking, Examination, an audio introduction, and a link to the Braingut “clinical sign of the day” on Twitter.

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The audio introduction features a three-minute conversation between an interviewer and Dr. Epstein, the creator of this app, and serves as a suitable introduction to the abdominal history and physical exam.

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We begin with the history-taking part of the app, which is divided into sections by organ.

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Here, we take a look at the liver section of history-taking.  Notice different complaints and categories, such as pain, non-specific symptoms, jaundice, cirrhosis, and risk factors for liver disease.  The controls at the top-right corner play a seven-minute conversation between the interviewer and Dr. Epstein that centers on the symptoms listed here.  These conversations are present for each of the sections of the history-taking as well as examination parts of the app, and consist of easily-listened-to back-and-forth question-and-answer sessions between the interviewer and Dr. Epstein whose content is appropriate for medical students.  The British accents, moreover, are delightful!  In total, the app offers over 90 minutes of these interviews with Dr. Epstein.

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Each link discusses the particular symptom, and then offers several questions appropriate for history-taking related to the symptom or concern.  A question can be selected to display information related to the significance of and rationale behind each question, in convenient bullet-point format.

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The Examination portion of the app features a step-by-step overview of a complete abdominal exam, beginning with extra-abdominal considerations.  The jump function allows for quick navigation to a particular step, as opposed to flipping step-by-step from the introduction screen.

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Here, we take a look at the liver and gallbladder portion of the physical exam.

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Each part of the physical exam offers two parts (as tabs at the bottom of the screen): examination and signs.  The examination portion, predictably, discusses different aspects of this part of the exam.  For example, here this includes liver surface markings, liver palpation, liver percussion, and gallbladder, all presented in convenient bullet-point format.  Of course, the audio controls in the top-right corner play an interview with Dr. Epstein concerning liver and gallbladder examination.

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The user’s device can be rotated to bring up photographs illustrating each of the discussed examination steps.

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This section also includes a simple animation of liver movement with inspiration and expiration.

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Moreover, clicking on the film camera icon in the top left portion of the screen brings up a short video (without instructional audio) instructing users on this part of the abdominal exam.

1617Clicking on the signs tab at the bottom of the screen allows for the selection of a liver abnormality, and generates a list of possible causes of or reasons for the selected abnormality.

As we have shown here, the app features several modalities of instruction, audio, text, video, illustrations, and photographs to teach users how to carry out a complete abdominal history and physical exam.

Compared with the recently reviewed Physical Exam Essentials (read here) , Answers in Abdominal Examination serves as a more in-depth review of the abdominal history and physical exam, as opposed to a broader, more fundamental basic survey of the complete physical exam (minus the musculoskeletal system).

Price:

  • The Answers in Abdominal Examination app costs $7.99 on the iTunes app store.

Likes:

  • Created by teaching physicians at London academic medical centers
  • Use of multiple instructional modalities including text, video, audio, illustrations, and photographs
  • Engaging and interactive user interface
  • Comprehensive overview of the abdominal exam

Dislikes/Future Updates:

  • Controls for navigating the various audio files could be made smoother
  • Though, admittedly, there is no great way to do it, the organization of the various examination steps vacillates between actual steps (inspection, palpation, percussion, etc.) and organs (liver, spleen, kidneys, etc.)

Summary:

  • For medical students interested in internal medicine, gastroenterology, or surgery, the Answers in Abdominal Examination app represents a worthwhile comprehensive overview of the abdominal history and physical exam presented in an easy-to-master, interactive format with multiple teaching modalities.

iTunes Link: http://itunes.apple.com/us/app/answersin-abdominal-examination/id436821371?mt=8