ABDOMINAL EXAMINATION Hakan Senturk, MD Department of Gastroenterology Medical Faculty Bezmi Alem University Istanbul
INTRODUCTION• GENERAL EXAMINATION• FOCUSED EXAMINATIONComplaintsGeneral personal historyFamily HistoryUse and abuse of substances
COMPONENTS OF AE• Inspection: The patient should be in a comfortable position with the drapes positioned conveniently. The light should be adequate and, if possible, tangenital.• Palpation: The hands should be clean and warm as well as gentle.• Percussion• Ausculatation: A high quality stethoscope should be used
INSPECTIONAbdominal contour:Bulging abdomen: Obezity, bowel distension,ascites, abdominal masses, pyloric obstruction.Obesity: A lax abdomen. No change in umbilicusAscites: Effacement of umbilicus and in advancedcases, extrovertion and even, herniation of bowelloops.Bowel distension due to meteorism: No change inumbilicus intravertion. Moderate Pain. Normalbowel sounds.
INSPECTION• Bowel distension due to ileus: Hypo- (adynamic ileus) or hyper-active bowel sounds (visible peristalsis).• Splenomegaly, Hepatomegaly, over-distended stomach (succisson splash), gall-bladder (hydrops vesicular), bladder.
PALPATION• Superficial and Deep Palpation:• Superficial palpation: Tenderness, extraabdominal masses (lipoma, myoma, fibroma, hematoma etc.)• Deep Palpation: Liver, spleen, kidneys, gall bladder, appendix. Intraabdominal tumours. Rebound tenderness.
PERCUSSION• Measurement of the vertical diameter of the liver.• Traube space for mild splenomegaly.• Diagnosis and evaluation of ascites.
Auscultation• Evaluation of bowel sounds.• Bruits: Renal artery stenosis.
PATIENT 1• Fifty-five years old male presented with right hypochondrial fullness of years of duration.• The discomfort worsens in sitting position, especially, while driving.• His BMI is 31 kg/m2. His medical history is insignificant. He neither smokes nor consume alcoholic beverages.• His father is alive and also obese, and his mother has type II diabetes.
• In physical examination of abdomen, the liver is palpable three centimeters below right coastal margin, on midclavicular line in inspiration. The liver edge is relatively hard and tender that the patient stops respiration when the examiner hand touches the liver.• Final diagnosis: Fatty liver.
PATIENT 2• 27 years old women presents with pain in abdomen which worsens with effort.• She had a long standing infection after delivery two years ago. Otherwise her medical history is negative.• Inspection of the abdomen reveals a slightly retracted abdomen with protuberence of left hypochondrial and colic regions. A close look reveals it is solis and moves with breathing.
PATIENT 2• The palpation of the mass reveals that it is a moderately smooth mass which originates form left lower intrathoracic region. Its surface is smooth and it is not tender.• The liver is not palpable and there is no ascites.• Final diagnosis: Splenomegaly due to nğn- cirrhotic portal hypertension.
PATIENT 3• Fifty-five year old gentleman presents with diarrheic episodes of two months of duration.• Apetite is unimpaired and there is no weight loss.• Abdominal palpation reveals an almost seven centimeters measuring mass in the left iliac region. It is hard and relatively fixated.• Final diagnosis: Advanced sigmoid carcinoma
PATIENT 4• 29 years old lady presents with progressive swelling of abdomen for a few months, loss of apetite and significant weight loss. Night sweating is reported as well.• Abdominal inspection reveals a distended abdomen with effacement of umbilicus. Palpation reveals slight tenderness without rebound. Percussion reveals a dulness in the lower part of abdomen. However dulness is not homogenous with intervening areas of typanism.
PATIENT 5• You are before a male, 49 years old who came for a check-up examination for insurance. He has no complaint. His BMI is 26 Kg/m2.• His blood pressure is 170/105 mmHg. He said, his blood pressure is sometimes found high.• In deep palpation of abdomen you feel the edge of something hard in the right lumbar (or colic) region in deep inspiration. The patient said, they found hepatomegaly in a previous examination.
PATIENT 5• However you are suspicous of this finding and you put your left hand on the back of the patient and you feel a ballottment of what you noticed. Additionally, the liver edge is distinctly palpable. The mass is not painful.• Final diagnosis: Hydronephrosis.
PATIENT 6• Fifty-eight years old man was examined for the complaint of abdominal fullness and pain of nearly one year duration. No change in bowel habits, no weight loss.• Abdominal examination revealed slight distension with sensitivity. Spasmolytic was prescribed.
PATİENT 6• The next day, patient’s complaints increased and was admitted to the emergency unit with acute abdomen.• Laparatomy was performed and revealed a distended and inflamed appendix and terminal ileum. Resection was performed.• Histology showed a carcinoid tumour originating from ileum.
PATIENT 7• 31 years old male was admitted with upper GI bleeding. He did not require blood transfusion and endoscopy revealed, a probable resolving hemorrhagic gastritis.• However, a later palpation of abdomen revelaed a mass which is not apparent in inspection. The mass was filling all abdomen but right inguinal region.• Schwannoma originating form Stomach.
• In laparatomy a mass involving stomach and spleen measuring 25 cm. was found and removed alongside part of the stomach with splenectomy.• Histologic examination revelaed Schwannoma.• Interestingly the patient neither reported a previous abodminal complaint or a relief after operation.