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abdominalexamination-150913180504-lva1-app6891 (1).pptx
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- 2. COMMON COMPLAINTS Anorexia Nausea vomitingDysphagia flatulance Retrosternal Burning Diarrhoea Constipation Clay colour stool Worms/mucous in stool Black tarry stool Abdominal pain/ lump Abdominal distension Hematemesis Melena Epistaxis Bleeding per rectum
- 3. PAST HISTORY Tuberculosis malaria Kalaazar Leukemia Hemolytic crisis Sexual contact Bleeding disorder H/O Blood transfusion Surgery Jaundice
- 4. POSITIONING • Abdomen canbe divided in four quadrants • Patient should be lying on supine position
- 5. REGIONAL DIVISION OFABDOMEN
- 6. 6 Liver: left lobe Spleen Stomach Jejunumand proximal ileum Pancreas: body and tail Left Kidney Left Suprarenal gland Left colic (splenic) flexure Transverse colon: left half Descending colon: superior part LEFT UPPER QUADRANT
- 7. 7 RIGHT UPPER QUADRANT Liver:right lobe Gallbladder – Murphy’s sign Stomach: pylorus Duodenum: parts 1-3 Pancreas: head Right suprarenal gland Right kidney Right colic (hepatic) flexure Ascending colon: superior part Transverse colon: right half
- 8. 8 RIGHT LOWER QUADRANT Cecum Vermiformappendix Most of ileum Ascending colon: inferior part Right ovary Right uterine tube Right spermatic cord Uterus (if enlarged) Urinary bladder (if full)
- 9. 9 LEFT LOWER QUADRANT Sigmoidcolon Descending colon: inferior part Left ovary Left uterine tube Left ureter: abdominal part Left spermatic cord: abdominal part Uterus (if enlarged) Urinary bladder (if full)
- 10. INSPECTION • Shape andmovements • Scars • Distension • Prominent veins • Striae • Bruises • Pigmentation • Visible peristalsis - pyloric stenosis- left to right large intestine obstruction- left to right
- 11. normal pregnancy ascitesfatty abdomen SHAPE
- 12.
- 13. ABDOMINAL MOVEMENT • Normal: –Male : Abdomino-thoracic – Female : Thoraco-abdominal – Infant : Thoraco- abdominal • Disease : – Diaphragmatic palsy : bulging during expiration – Peritonitis : no movement
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- 16. PALPATION 1. Ensure thatyour hands are warm 2. Stand on the patient’s right side 3. Help to position the patient 4. Ask whether the patient feels any pain before you start 5. Begin with superficial examination 6. Move in a systematic manner through the abdominal quadrants 7. Repeat palpation deeply.
- 17. PALPATION • Characteristics ofan abdominal mass 1. location 2. size 3. shape 4. consistency 5. surface 6. tenderness 7. movable or fixed 8. shifting by respiration
- 18.
- 19.
- 20. PALPATION • Tenderness: discomfortand resistance to palpation • Involuntary guarding: reflex contraction of the abdominal muscles • Rebound tenderness: patient feels pain when the hand is released • Tenderness + rigidity: perforated viscus • Palpable mass (enlarged organ, faeces, tumour) • Aortic pulsation
- 21. • Pain inRUQ • Inflammation of gallbladder (cholecystitis) MURPHY’S SIGN
- 22. • 1/3 ASISto umbilicus • Location of AV in retrocecal position • Deep tenderness (= acute appendicitis) MCBURNEY’S POINT
- 23. rebound tenderness • Painupon removal of pressure rather than application of pressure to the abdomen • Peritonitis and/ or appendicitis BLUMBERG’S SIGN
- 24. PALPATION OF THELIVER 1. Flex the knee joint 2. Ask the patient to take a deep breath in 3. Start palpating in the right iliac fossa 4. Move hand progressively further up the abdomen 5. Try to feel the liver edge 6. Check for tha liver span.
- 26. PALPATION OF THESPLEEN 1. Roll the patient towards you 2. Start from right illiac fossa 3. Palpate with right hand while using left hand to press forward on the patient’s lower ribs from behind 4. Feel along the costal margin
- 27. SPLEENOMEGALY • Traube's Spaceboundaries -Left anterior axillary line, 6th rib, costal margin • Castell’s - resonating traube’s area Nixon’s method - dullness extends >8 cm
- 29.
- 30. PERCUSSION • Dull sounds:solid or fluid-filled structures • Resonant sounds: structures containing air or gas • Shifting dullness
- 31. AUSCULTATION • Place thediaphragm of the stethoscope to the right of the umbilicus • Bowel sounds (borborygmi) are caused by peristaltic movements • Occur every 5-10 sec. • Absence of b.s.: paralytic ileus or peritonitis • Bruits over aorta and renal a. could be a sign of an aneurysm and stenosis
Editor's Notes
- #4 In order to accurately localize the findings on physical examination, one usually divides the abdomen into four quadrants: Upper right and left Lower right and left The dividing lines are: Vertically, a connecting line between the xiphoid process and the pubic symphysis; Horizontally, a line across the umbilicus. Examine the patient in good light and warm surroundings. Position the patient comfortably supine with the head resting on one pillow in order to relax the muscles of the abdominal wall.
- #6 Spleen Between 9th - 11th ribs Does not extend inferior to the left costal margin
- #7 Liver Lied deep to ribs 7 through 11 and crosses midline to left nipple Sharp inferior border follows right costal margin More inferior when erect Inspire deeply and may palpate Place left hand posteriorly between right 12th rib and iliac crest then place right hand on right upper quadrant - pt takes a deep breath Gallbladder – Murphy’s sign
- #10 Shape and movements with respiration – flat or slightly scaphoid (shaped like a boat) Scars from previous surgical procedures Distension Localised: malignancy, hepatopathy, splenomegaly Generalized: Fat (obesity), fluid (ascites), flatus (obstruction), faeces (constipation), fetus (pregnancy) Prominent veins (caput medusae) in portal hypertension blood flows trough portocaval anastomoses. Image: end stage liver disease Striae Visible peristalsis
- #16 Leave the painful area for last. Move in a systematic manner through the nine regions of the abdomen in the direction of the painful area. Make sure you use the pads of your fingers and not the finger tips as this might hurt the patient.
- #20 ABNORMAL FINDINGS
- #21 Murphy's sign sign of gallbladder disease consisting of pain on taking a deep breath when the examiner's fingers are on the approximate location of the gallbladder. Pain on inspiration during gentle palpation below the right subcostal arch. As the patient breathes in, the liver moves down exposing the gallbladder to pressure from the examiners hand. Murpy’s sign may also be present with hepatitis. The gallbladder (GB) is filled with echogenic sludge (Sl) and a gallstone (red arrow) is impacted in the gallbladder neck. The gallbladder wall (red arrowheads) is markedly thickened indicative of wall edema and there are pericholecystic fluid (blue arrows) pockets surrounding the gallbladder. Courvoisier's law states that in the presence of an enlarged gall bladder which is nontender and accompanied with jaundice, the cause is unlikely to be gallstones.
- #22 From ASIS (anterior superior iliac spine) to the umbilicus. Determines: - location of appendix (varies) - deep tenderness @ point = acute appendicitis
- #24 Try to feel the liver edge and work out if it is enlarged or displaced downwards.
- #26 Try to feel the liver edge and work out if it is enlarged or displaced downwards.