This document provides information about examining the abdomen. It describes how the abdomen is divided into 9 regions by vertical and horizontal planes. It discusses inspecting the anterior and back aspects of the abdominal wall and lists things to look for. Methods for examining the liver, spleen, hernias and signs of cirrhosis are outlined. Deep palpation techniques like bimanual, dipping and hooking are explained. The nature of palpable organs is discussed.
This document discusses a case of lung consolidation seen in a patient. It provides definitions and causes of lung consolidation, including pneumonia, malignancy, and infarction. Differential diagnoses for consolidation are discussed. The document also contains sections on carcinoma of the lung, bronchial carcinoma, clinical features, investigations, management, and classifications of pneumonia by pathogen, anatomy, presentation, duration, and environment.
Hepatomegaly is an enlarged liver which has many potential causes that can be broadly categorized as infection, toxicity, tumors, or metabolic disorders. Common infectious causes include mononucleosis, hepatitis, malaria, and amoebic infections. Neoplastic causes include liver cancer, myeloma, leukemia, and lymphoma. Cirrhosis, portal hypertension, and metabolic disorders like fatty infiltration can also result in hepatomegaly. Investigations include blood tests of liver function and imaging scans, while differential diagnosis considers inflammation, infiltration, storage abnormalities, and primary or metastatic liver tumors.
The spleen normally lies under the diaphragm in the left upper abdomen and is not palpable unless it increases to three times its normal size. There are several methods to palpate an enlarged spleen including the classical, bimanual, hooking, and dipping methods. The size of splenomegaly can be classified as mild, moderate, or severe based on the distance of the spleen from the left costal margin. A palpable spleen will have a sharp edge, angular poles, and characteristics like moving with respiration.
This document describes three percussion techniques: tidal percussion, Traube's space percussion, and Kronig's isthmus percussion. Tidal percussion distinguishes between liver/spleen enlargement and intrathoracic issues by checking dullness changes with inspiration and expiration. Traube's space percussion checks the stomach fundus tympanicity. Kronig's isthmus percussion checks the lung resonance between the neck and shoulder.
1. The document discusses different types of hernias, including inguinal, femoral, umbilical, incisional, and rare types.
2. It provides details on examining patients for hernias, such as observing for visible lumps, checking for cough impulse, and performing reducibility tests.
3. Key factors are described for differentiating between direct and indirect inguinal hernias, as well as differentiating inguinal from femoral hernias based on location and examination findings.
This document provides information on clinically examining the spleen through inspection, palpation, and percussion. It discusses what constitutes a normal versus enlarged spleen size. When palpating the spleen, it should be felt below the left costal margin and enlarge downwards towards the right lower quadrant. Percussion can identify splenic dullness extending into the left upper quadrant. Features of a splenic mass include a firm, rounded edge that is dull to percussion and moves down on inspiration but cannot be pushed between the examiner's hands or felt above the costal margin.
This document discusses bilateral hydrocele, which is a fluid collection around the testes. It defines different types of hydrocele including congenital, infantile, encysted, and secondary to infections. Key features include a fluctuant, transilluminant swelling above the scrotum without palpable testes. Complications can include infection, infertility, and testicular atrophy. Differential diagnoses include hernia and tumors. Treatment involves surgical techniques like Lord's plication, evacuation and eversion, or subtotal excision depending on size and characteristics of the hydrocele sac.
This document discusses a case of lung consolidation seen in a patient. It provides definitions and causes of lung consolidation, including pneumonia, malignancy, and infarction. Differential diagnoses for consolidation are discussed. The document also contains sections on carcinoma of the lung, bronchial carcinoma, clinical features, investigations, management, and classifications of pneumonia by pathogen, anatomy, presentation, duration, and environment.
Hepatomegaly is an enlarged liver which has many potential causes that can be broadly categorized as infection, toxicity, tumors, or metabolic disorders. Common infectious causes include mononucleosis, hepatitis, malaria, and amoebic infections. Neoplastic causes include liver cancer, myeloma, leukemia, and lymphoma. Cirrhosis, portal hypertension, and metabolic disorders like fatty infiltration can also result in hepatomegaly. Investigations include blood tests of liver function and imaging scans, while differential diagnosis considers inflammation, infiltration, storage abnormalities, and primary or metastatic liver tumors.
The spleen normally lies under the diaphragm in the left upper abdomen and is not palpable unless it increases to three times its normal size. There are several methods to palpate an enlarged spleen including the classical, bimanual, hooking, and dipping methods. The size of splenomegaly can be classified as mild, moderate, or severe based on the distance of the spleen from the left costal margin. A palpable spleen will have a sharp edge, angular poles, and characteristics like moving with respiration.
This document describes three percussion techniques: tidal percussion, Traube's space percussion, and Kronig's isthmus percussion. Tidal percussion distinguishes between liver/spleen enlargement and intrathoracic issues by checking dullness changes with inspiration and expiration. Traube's space percussion checks the stomach fundus tympanicity. Kronig's isthmus percussion checks the lung resonance between the neck and shoulder.
1. The document discusses different types of hernias, including inguinal, femoral, umbilical, incisional, and rare types.
2. It provides details on examining patients for hernias, such as observing for visible lumps, checking for cough impulse, and performing reducibility tests.
3. Key factors are described for differentiating between direct and indirect inguinal hernias, as well as differentiating inguinal from femoral hernias based on location and examination findings.
This document provides information on clinically examining the spleen through inspection, palpation, and percussion. It discusses what constitutes a normal versus enlarged spleen size. When palpating the spleen, it should be felt below the left costal margin and enlarge downwards towards the right lower quadrant. Percussion can identify splenic dullness extending into the left upper quadrant. Features of a splenic mass include a firm, rounded edge that is dull to percussion and moves down on inspiration but cannot be pushed between the examiner's hands or felt above the costal margin.
This document discusses bilateral hydrocele, which is a fluid collection around the testes. It defines different types of hydrocele including congenital, infantile, encysted, and secondary to infections. Key features include a fluctuant, transilluminant swelling above the scrotum without palpable testes. Complications can include infection, infertility, and testicular atrophy. Differential diagnoses include hernia and tumors. Treatment involves surgical techniques like Lord's plication, evacuation and eversion, or subtotal excision depending on size and characteristics of the hydrocele sac.
Percussion of the respiratory system is used diagnostically to determine the state of underlying tissues and topographically to delineate organ borders. The examiner uses one finger (pleximeter) to percuss the chest wall and another (plessor) to strike it, varying the force based on factors like thickness and location. Different notes indicate conditions like consolidation, effusion, or pneumothorax. Special techniques include flicking and palpatory percussion. Topographic percussion maps areas like the lung borders and detects findings associated with diseases.
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
Liver abscesses can be pyogenic (caused by bacteria), amoebic (caused by Entamoeba histolytica), or fungal. Pyogenic liver abscesses are most commonly located in the right lobe due to blood flow patterns and are usually caused by gram-negative bacteria like E. coli. Patients present with fever, right upper quadrant pain, hepatomegaly, and diarrhea in some cases of amoebic abscess. Diagnosis involves blood tests, imaging like CT or ultrasound, and abscess fluid culture. Treatment is drainage of pus combined with antibiotics, usually percutaneous catheter drainage guided by imaging. For amoebic abscess, metronidazole is usually
Pallor is caused by decreased blood in the capillary bed, seen as paleness of the skin and mucous membranes. The most common cause is nutritional anemia such as iron deficiency anemia. Conditions causing pallor without anemia include hypopituitarism, hypothyroidism, and shock. Pallor can be graded as mild, moderate, or severe. Examination sites to check for pallor include the lower eyelid conjunctiva, tongue, hard palate, nail beds, and palms. Confirmation of anemia requires blood tests to measure hemoglobin levels, red blood cell count, and hematocrit.
This document provides guidance on examining patients for inguinal hernias. It details the steps of the examination including inspection, palpation techniques, and tests to determine the type and characteristics of any hernia present. The examination is described in both standing and supine positions. Differential diagnoses are also listed. The goal of the examination is to determine factors such as location, size, reducibility, and complications in order to accurately diagnose the presence of an inguinal hernia.
Parasternal heave is the forward movement of the lower left parasternal area that can be seen and felt during chest examination. It is graded on a scale of 1 to 3 based on whether the movement is visible only, visible and palpable but disappears with pressure, or visible, palpable and does not disappear with pressure. A parasternal heave indicates enlargement of the right ventricle or left atrium, which can be caused by conditions such as an atrial septal defect or pulmonary hypertension.
This document discusses acute and chronic cholecystitis. Acute cholecystitis typically occurs due to gallstone impaction and results in inflammation of the gallbladder. Common symptoms include fever, right upper quadrant pain, and nausea. Diagnosis involves physical exam findings like Murphy's sign along with supportive lab and ultrasound results showing gallstones, thickened gallbladder walls, and pericholecystic fluid. Treatment involves antibiotics, pain medication, and cholecystectomy usually within 3 days. Chronic cholecystitis is due to long-standing gallstones or cholecystoses and results in a thickened, non-functioning gallbladder. Cholecystectomy is the treatment for chronic cholecystitis.
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
This document discusses acute cholecystitis, which is inflammation of the gallbladder. It defines the condition and discusses its most common causes and risk factors. The main symptoms are abdominal pain in the right upper quadrant, nausea, vomiting, and fever. Diagnosis involves physical exam findings like Murphy's sign as well as imaging tests and bloodwork. Treatment involves intravenous fluids, antibiotics, and early cholecystectomy if symptoms worsen or complications arise. Both open and laparoscopic cholecystectomy are discussed as surgical treatment options.
Achalasia cardia is a primary esophageal motility disorder caused by loss of inhibitory ganglionic cells in the myentric plexus, resulting in failure of the lower esophageal sphincter to relax during swallowing. This leads to dilatation of the esophagus above the sphincter and difficulty swallowing (dysphagia). Common symptoms include dysphagia that is worse for liquids, regurgitation, chest pain, weight loss and recurrent pneumonia. Diagnosis is confirmed by barium swallow showing a dilated esophagus and absence of peristalsis on manometry. Treatment options include surgical cardiomyotomy to cut the sphincter muscles, pneumatic balloon dilation, or injection of
1. A 10-year-old boy presents with high fever, sore throat, and difficulty swallowing for 4 days. His tonsils are inflamed and enlarged with white membranes.
2. Differential diagnoses include membranous tonsillitis, diphtheria, infectious mononucleosis, leukemia, and peritonsillar abscess.
3. Membranous tonsillitis is caused by pyogenic organisms forming an exudative membrane over the tonsils. Diphtheria and infectious mononucleosis can also present with white membranes over the tonsils.
This document contains information on various biliary diseases including gallstones, cholangiocarcinoma, pancreatic cancer, and biliary strictures. It discusses the clinical presentation, investigations, and management of biliary obstructions of different types including those caused by stones, tumors, strictures, and cysts. The diagnosis and treatment of choledochal cysts and sclerosing cholangitis are also covered.
CafĂŠ-au-lait spots, neurofibromas, Lisch nodules, and axillary freckling are characteristic of neurofibromatosis type 1. Plexiform neurofibromas appear as subcutaneous elastic tumors over the face, scalp, neck and chest. Adenoma sebaceum presents as numerous discrete smooth papules over the butterfly area of the face and nasolabial folds. Shagreen patches are irregular cobblestone-like plaques in the lumbosacral area, a characteristic of tuberous sclerosis. Ocular and cutaneous telangiectasias occur in Ataxia telangiectasia, appearing as dilated blood vessels over
The document provides information on acute abdomen including its definition, epidemiology, physiology, differential diagnosis by location, history and physical examination findings, important investigations, management principles, and criteria for surgical consultation. Acute abdomen is defined as sudden severe abdominal pain lasting less than 24 hours that often requires urgent diagnosis and some causes need surgical treatment. The differential diagnosis considers location of pain and includes conditions like appendicitis, diverticulitis, bowel obstruction, pancreatitis and others. Key aspects of evaluation involve history, physical exam, labs, imaging and identifying high-risk patients who may require emergent surgery.
This document discusses hepatomegaly (enlargement of the liver). It begins by describing the normal anatomy and functions of the liver. It then discusses the various mechanisms that can cause hepatomegaly, including increased cell size/number, inflammation, infiltration, increased vascular/biliary space, and idiopathic causes. The main causes of hepatomegaly are listed as infective, congestive, degenerative/infiltrative, storage disorders, neoplasia, and toxins. The document concludes by describing the clinical presentation and examination findings of hepatomegaly.
This document provides information on various aspects of physical examination including:
- Vital signs measurement including temperature, pulse, respiratory rate, and blood pressure.
- Examination of the skeletal structure and causes of short and tall stature.
- Assessment of nutritional status and signs of deficiencies.
- Description of pallor, icterus, cyanosis, clubbing, lymphadenopathy, and edema - including causes and assessment.
Ulcerative colitis is a chronic inflammatory bowel disease that affects the colon. It is characterized by inflammation and ulcers in the lining of the rectum and colon. The causes are unknown but likely involve genetic and immune factors. Symptoms include abdominal pain, bloody diarrhea, and weight loss. Diagnosis involves blood tests, colonoscopy, and biopsy. Treatment focuses on reducing inflammation through medications like mesalamine, corticosteroids, immunosuppressants, or biologics. Surgery to remove the colon may be needed for severe cases or cancer prevention. Complications can include toxic megacolon, colon cancer, and extraintestinal manifestations.
The gallbladder is a hollow organ located beneath the liver that stores and concentrates bile. Cholecystitis is inflammation of the gallbladder, usually caused by gallstones blocking the cystic duct. Symptoms include pain in the upper right abdomen and fever. Ultrasound is often used to diagnose cholecystitis by detecting gallstones or thickening of the gallbladder wall. Treatment typically involves surgical removal of the gallbladder via laparoscopy.
This document discusses endometriosis and adenomyosis. Endometriosis occurs when endometrial tissue grows outside the uterus, most commonly on the ovaries and pelvic peritoneum. It causes pain and can lead to infertility. Adenomyosis involves the growth of endometrial tissue into the uterine muscle. Both can cause heavy periods and pain. Treatment involves medication, surgery, or hysterectomy depending on symptoms and desire for future fertility.
Methods of gaining space -Extraction /certified fixed orthodontic courses by ...Indian dental academy
Â
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Percussion of the respiratory system is used diagnostically to determine the state of underlying tissues and topographically to delineate organ borders. The examiner uses one finger (pleximeter) to percuss the chest wall and another (plessor) to strike it, varying the force based on factors like thickness and location. Different notes indicate conditions like consolidation, effusion, or pneumothorax. Special techniques include flicking and palpatory percussion. Topographic percussion maps areas like the lung borders and detects findings associated with diseases.
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
Liver abscesses can be pyogenic (caused by bacteria), amoebic (caused by Entamoeba histolytica), or fungal. Pyogenic liver abscesses are most commonly located in the right lobe due to blood flow patterns and are usually caused by gram-negative bacteria like E. coli. Patients present with fever, right upper quadrant pain, hepatomegaly, and diarrhea in some cases of amoebic abscess. Diagnosis involves blood tests, imaging like CT or ultrasound, and abscess fluid culture. Treatment is drainage of pus combined with antibiotics, usually percutaneous catheter drainage guided by imaging. For amoebic abscess, metronidazole is usually
Pallor is caused by decreased blood in the capillary bed, seen as paleness of the skin and mucous membranes. The most common cause is nutritional anemia such as iron deficiency anemia. Conditions causing pallor without anemia include hypopituitarism, hypothyroidism, and shock. Pallor can be graded as mild, moderate, or severe. Examination sites to check for pallor include the lower eyelid conjunctiva, tongue, hard palate, nail beds, and palms. Confirmation of anemia requires blood tests to measure hemoglobin levels, red blood cell count, and hematocrit.
This document provides guidance on examining patients for inguinal hernias. It details the steps of the examination including inspection, palpation techniques, and tests to determine the type and characteristics of any hernia present. The examination is described in both standing and supine positions. Differential diagnoses are also listed. The goal of the examination is to determine factors such as location, size, reducibility, and complications in order to accurately diagnose the presence of an inguinal hernia.
Parasternal heave is the forward movement of the lower left parasternal area that can be seen and felt during chest examination. It is graded on a scale of 1 to 3 based on whether the movement is visible only, visible and palpable but disappears with pressure, or visible, palpable and does not disappear with pressure. A parasternal heave indicates enlargement of the right ventricle or left atrium, which can be caused by conditions such as an atrial septal defect or pulmonary hypertension.
This document discusses acute and chronic cholecystitis. Acute cholecystitis typically occurs due to gallstone impaction and results in inflammation of the gallbladder. Common symptoms include fever, right upper quadrant pain, and nausea. Diagnosis involves physical exam findings like Murphy's sign along with supportive lab and ultrasound results showing gallstones, thickened gallbladder walls, and pericholecystic fluid. Treatment involves antibiotics, pain medication, and cholecystectomy usually within 3 days. Chronic cholecystitis is due to long-standing gallstones or cholecystoses and results in a thickened, non-functioning gallbladder. Cholecystectomy is the treatment for chronic cholecystitis.
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
This document discusses acute cholecystitis, which is inflammation of the gallbladder. It defines the condition and discusses its most common causes and risk factors. The main symptoms are abdominal pain in the right upper quadrant, nausea, vomiting, and fever. Diagnosis involves physical exam findings like Murphy's sign as well as imaging tests and bloodwork. Treatment involves intravenous fluids, antibiotics, and early cholecystectomy if symptoms worsen or complications arise. Both open and laparoscopic cholecystectomy are discussed as surgical treatment options.
Achalasia cardia is a primary esophageal motility disorder caused by loss of inhibitory ganglionic cells in the myentric plexus, resulting in failure of the lower esophageal sphincter to relax during swallowing. This leads to dilatation of the esophagus above the sphincter and difficulty swallowing (dysphagia). Common symptoms include dysphagia that is worse for liquids, regurgitation, chest pain, weight loss and recurrent pneumonia. Diagnosis is confirmed by barium swallow showing a dilated esophagus and absence of peristalsis on manometry. Treatment options include surgical cardiomyotomy to cut the sphincter muscles, pneumatic balloon dilation, or injection of
1. A 10-year-old boy presents with high fever, sore throat, and difficulty swallowing for 4 days. His tonsils are inflamed and enlarged with white membranes.
2. Differential diagnoses include membranous tonsillitis, diphtheria, infectious mononucleosis, leukemia, and peritonsillar abscess.
3. Membranous tonsillitis is caused by pyogenic organisms forming an exudative membrane over the tonsils. Diphtheria and infectious mononucleosis can also present with white membranes over the tonsils.
This document contains information on various biliary diseases including gallstones, cholangiocarcinoma, pancreatic cancer, and biliary strictures. It discusses the clinical presentation, investigations, and management of biliary obstructions of different types including those caused by stones, tumors, strictures, and cysts. The diagnosis and treatment of choledochal cysts and sclerosing cholangitis are also covered.
CafĂŠ-au-lait spots, neurofibromas, Lisch nodules, and axillary freckling are characteristic of neurofibromatosis type 1. Plexiform neurofibromas appear as subcutaneous elastic tumors over the face, scalp, neck and chest. Adenoma sebaceum presents as numerous discrete smooth papules over the butterfly area of the face and nasolabial folds. Shagreen patches are irregular cobblestone-like plaques in the lumbosacral area, a characteristic of tuberous sclerosis. Ocular and cutaneous telangiectasias occur in Ataxia telangiectasia, appearing as dilated blood vessels over
The document provides information on acute abdomen including its definition, epidemiology, physiology, differential diagnosis by location, history and physical examination findings, important investigations, management principles, and criteria for surgical consultation. Acute abdomen is defined as sudden severe abdominal pain lasting less than 24 hours that often requires urgent diagnosis and some causes need surgical treatment. The differential diagnosis considers location of pain and includes conditions like appendicitis, diverticulitis, bowel obstruction, pancreatitis and others. Key aspects of evaluation involve history, physical exam, labs, imaging and identifying high-risk patients who may require emergent surgery.
This document discusses hepatomegaly (enlargement of the liver). It begins by describing the normal anatomy and functions of the liver. It then discusses the various mechanisms that can cause hepatomegaly, including increased cell size/number, inflammation, infiltration, increased vascular/biliary space, and idiopathic causes. The main causes of hepatomegaly are listed as infective, congestive, degenerative/infiltrative, storage disorders, neoplasia, and toxins. The document concludes by describing the clinical presentation and examination findings of hepatomegaly.
This document provides information on various aspects of physical examination including:
- Vital signs measurement including temperature, pulse, respiratory rate, and blood pressure.
- Examination of the skeletal structure and causes of short and tall stature.
- Assessment of nutritional status and signs of deficiencies.
- Description of pallor, icterus, cyanosis, clubbing, lymphadenopathy, and edema - including causes and assessment.
Ulcerative colitis is a chronic inflammatory bowel disease that affects the colon. It is characterized by inflammation and ulcers in the lining of the rectum and colon. The causes are unknown but likely involve genetic and immune factors. Symptoms include abdominal pain, bloody diarrhea, and weight loss. Diagnosis involves blood tests, colonoscopy, and biopsy. Treatment focuses on reducing inflammation through medications like mesalamine, corticosteroids, immunosuppressants, or biologics. Surgery to remove the colon may be needed for severe cases or cancer prevention. Complications can include toxic megacolon, colon cancer, and extraintestinal manifestations.
The gallbladder is a hollow organ located beneath the liver that stores and concentrates bile. Cholecystitis is inflammation of the gallbladder, usually caused by gallstones blocking the cystic duct. Symptoms include pain in the upper right abdomen and fever. Ultrasound is often used to diagnose cholecystitis by detecting gallstones or thickening of the gallbladder wall. Treatment typically involves surgical removal of the gallbladder via laparoscopy.
This document discusses endometriosis and adenomyosis. Endometriosis occurs when endometrial tissue grows outside the uterus, most commonly on the ovaries and pelvic peritoneum. It causes pain and can lead to infertility. Adenomyosis involves the growth of endometrial tissue into the uterine muscle. Both can cause heavy periods and pain. Treatment involves medication, surgery, or hysterectomy depending on symptoms and desire for future fertility.
Methods of gaining space -Extraction /certified fixed orthodontic courses by ...Indian dental academy
Â
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Space regainers /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document provides information on cleft lip and cleft palate including definitions, incidence rates, development, classifications, problems associated, and treatment protocols. It defines cleft lip as an opening in the upper lip and cleft palate as an opening in the roof of the mouth. Treatment is a multidisciplinary approach involving surgery to repair the cleft, orthodontics to align teeth and jaws, and speech therapy. Management occurs over many years from infancy through adulthood to address dental, esthetic, speech and other issues.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses various orthodontic techniques used to gain space for tooth movement, including proximal stripping, expansion, extraction, distalization, molar uprighting, posterior tooth derotation, and anterior tooth proclination. It provides details on when and how to use each technique, their advantages and disadvantages, and diagnostic aids. The goal of these space gaining techniques is to correct malocclusions by moving teeth into more ideal positions.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Methods of space gaining in orthodontics / /certified fixed orthodontic cours...Indian dental academy
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Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
This document discusses pontics, which are the artificial teeth used to replace missing natural teeth in fixed partial dentures (FPDs). It covers topics such as pre-treatment assessment of the pontic space and residual ridge contour, biological and mechanical considerations when designing pontics, esthetic factors, and different types of pontic materials and their indications. Key points include the importance of passive tissue contact with the pontic, preventing plaque accumulation between the pontic and ridge, using rigid materials that can withstand occlusal forces, and matching the shape and size of replacement pontics to the adjacent natural teeth for esthetics.
The document discusses various methods for gaining space in orthodontic treatment, including proximal stripping, expansion, extraction, distalization, uprighting molars, and derotation of posterior teeth. It provides details on specific appliances and techniques used for different methods, such as slow expansion devices like Coffin springs and quad helix appliances for expansion, and headgear, pendulum appliances, and Jones jigs for molar distalization. It also covers indications and contraindications for these various space gaining strategies.
This document discusses various methods for gaining space in orthodontic treatment, including proximal stripping, arch expansion, extraction, distalization of molars, uprighting tilted molars, derotation of posterior teeth, and proclination/flaring of anterior teeth. It provides details on techniques such as rapid maxillary expansion using devices like Hyrax or bonded expanders, extraction of first premolars, and distalization of molars using appliances like pendulum or Jones Jig. The document also covers indications, advantages, and disadvantages of different space gaining methods.
The document describes the anatomy and examination of the abdomen, including divisions of the abdominal regions, inspection of the front and back, and palpation techniques for organs like the liver and spleen. Methods of palpation include single-handed, two-handed, bimanual, dipping and hooking. Findings from palpation include comments on organ size, borders, surface, consistency and tenderness.
The document provides details on the anatomy of the abdominal cavity and its contents. It describes the peritoneal cavity and mesenteries that support the intestines. It summarizes the liver, gallbladder and associated ducts. It outlines the locations and blood supply of the stomach, spleen, pancreas, small intestine and large intestine. It also reviews the anatomy of the kidneys, ureters, urinary bladder, and suprarenal glands.
This document provides an overview of splenomegaly, including the anatomy and functions of the spleen, causes of splenomegaly, examination techniques, classification of splenomegaly by size, potential symptoms, initial lab and imaging workup, and step-wise approach to evaluating a patient with splenomegaly. Common causes discussed include infections such as viral hepatitis, infiltrative diseases such as Gaucher's disease, malignancies such as lymphoma, and congestive states related to conditions like cirrhosis.
This document provides guidance on performing a peripheral vascular examination, including examining the arms and legs to check for signs of vascular disease. It describes how to inspect and palpate pulses in the upper and lower limbs, listen for bruits, and perform additional tests like Buerger's angle test. The document also covers examining the venous system, including inspection for varicose veins, palpating for fascial defects, and tests like Trendelenburg's test to check for venous incompetence.
The document provides details on performing an abdominal examination, including inspection, auscultation, percussion, and palpation techniques to examine the liver, spleen, kidneys, aorta, and assess for ascites. Key steps include listening for bowel sounds, percussing and palpating the liver span and spleen, assessing aortic pulsations, and tests for shifting dullness and a fluid wave to detect ascites.
The document provides guidance on performing an abdominal examination. It describes general rules for both the examiner and patient. Inspection begins with observing the contour of the abdomen and proceeds down the midline, noting features like the subcostal angle, epigastric pulsation, and umbilicus. Palpation techniques including light superficial palpation and deeper palpation are outlined. The spleen can be palpated using various methods like bimanual examination in both the supine and right lateral positions. Nature of any palpable spleen should be commented on.
ANATOMY OF UTERUS
ANATOMY OF OVARY
ANATOMY OF FALLOPIAN TUBES
ANATOMY OF UTERUS &ITS APPENDAGES
ANATOMY OF CERVIX
ANATOMY OF UTERUS PPT
BLOOD SUPPLY, NERVE SUPPLY, LYMPHATIC DRAINAGE
HISTOLOGY
The document provides an overview of the anatomy of the uterus and its appendages. It describes the uterus as a thick-walled, muscular organ located in the pelvis between the bladder and rectum. The uterus has two main parts - the body and the cervix. It is supplied by the uterine arteries and innervated by both the sympathetic and parasympathetic nervous systems. The fallopian tubes connect the ovaries to the uterus and the ovaries contain follicles that release eggs. The broad ligaments attach the uterus to the pelvic wall and contain the uterine tubes, vessels and ligaments.
The document provides information on the anatomy of the spleen:
1. The spleen lies obliquely along the 10th rib on the left side of the abdomen and acts as a filter for blood and plays an important role in immune responses.
2. It has an irregular shape with two ends, three borders, and two surfaces. Blood enters through the hilum located between the superior and intermediate borders.
3. The spleen has various relations within the abdomen and impressions on its surface from neighboring organs. It receives its blood supply from the splenic artery and drains into the splenic vein.
The document provides information on the anatomy and functions of the spleen:
- The spleen is a wedge-shaped organ located in the left upper quadrant of the abdomen between the stomach and diaphragm. It acts as a blood filter and plays a role in immune responses.
- The spleen has an irregular surface with impressions from adjacent organs like the stomach, kidney, and pancreas. It is supplied by branches of the splenic artery and drained by the splenic vein.
- Histologically, the spleen contains red pulp with sinusoids that filter blood and white pulp with lymphoid tissue. The spleen functions to filter blood, produce lymphocytes, store red blood cells, and remove old or damaged
This document provides a detailed overview of the radiologic anatomy and vascular supply of the small and large intestines. It discusses the anatomy and vascular supply of the duodenum, jejunum, ileum, cecum, appendix, colon, and pancreas. It also describes some congenital anomalies of the pancreas, including agenesis of the dorsal pancreas. Key points include the locations and branches of the celiac axis, superior mesenteric artery, and inferior mesenteric artery, which supply the intestines, as well as anatomical landmarks like the ligament of Treitz.
The gastrointestinal system consists of the tubular digestive tract and accessory digestive glands. The tract extends from the mouth to the anus and includes the esophagus, stomach, small intestine (duodenum, jejunum and ileum), large intestine, rectum and anal canal. Accessory glands include the salivary glands, liver and pancreas. The anterior abdominal wall has layers of skin, fascia and muscles including the external oblique, internal oblique, and transversus abdominis muscles. It receives blood supply from branches of the intercostal, subcostal and femoral arteries and drains into the superior and inferior vena cava.
The spleen is a wedge-shaped, highly vascular organ located in the left hypochondrium. It filters blood and plays an important role in immunity. The spleen lies obliquely along the 10th rib at a 45 degree angle. It has two surfaces - a diaphragmatic surface and a concave, irregular visceral surface with impressions for adjacent organs. The splenic artery supplies the spleen and the splenic vein drains into the portal vein. The spleen filters blood, removes old red blood cells, and plays a role in immune responses through lymphocyte activation and plasma cell production.
The spleen is normally located in the left upper quadrant of the abdomen. This case presents a 20-year-old female with abdominal pain who was found to have a torsed wandering spleen at the center of her abdomen. Wandering spleen is a condition where the spleen lacks normal ligamentous support, causing it to be mobile within the abdomen. At surgery, her enlarged spleen was found to have torsed along its vascular pedicle, cutting off its blood supply. A splenectomy was performed to remove the non-viable spleen. Histopathology confirmed splenic infarction due to the torsion.
The urinary system includes the kidneys, ureters, urinary bladder, and urethra. The kidneys filter the blood to remove wastes and produce urine. The ureters are tubes that carry urine from the kidneys to the bladder. The bladder stores urine until urination. The urethra then carries urine from the bladder to the outside of the body. Key structures of the urinary system were described in detail including locations, blood supply, and clinical relevance.
This document provides guidance on performing a thorough abdominal examination, including inspection, palpation, percussion, auscultation, and rectal examination. The examination involves assessing the patient's general nutritional and liver disease status, systematically palpating and percussing the abdomen in different regions to check for tenderness, masses, organomegaly and ascites, and listening for bowel sounds or other abnormalities. A rectal examination evaluates the anus, prostate or cervix, and stool for signs of bleeding or infection. The goal is to detect any abnormalities that may indicate underlying gastrointestinal or other intra-abdominal diseases.
The pancreas lies transversely in the retroperitoneum. It has a head, neck, body, and tail. The pancreatic duct drains into the common bile duct to form the ampulla of Vater. The pancreas receives its blood supply from branches of the splenic artery and superior mesenteric artery. It has both exocrine and endocrine functions. There are several types of pancreatic resection including pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy. Resection is indicated for tumors while reconstruction aims to restore gastrointestinal continuity.
The document discusses the pancreas and provides details about its location, morphology, blood supply, histology and more. Key points include:
- The pancreas is located transversely across the posterior abdominal wall behind the stomach from the duodenum to the spleen.
- Morphologically it has a head, neck, body and tail.
- It functions as both an exocrine gland that secretes enzymes and an endocrine gland that produces hormones like insulin and glucagon.
- The main pancreatic duct drains the gland and opens into the duodenum along with the common bile duct.
- The pancreas has both exocrine and endocrine components and its histology and blood supply are
The pancreas is a J-shaped gland located in the abdomen. It has exocrine functions that help digest nutrients and endocrine functions that regulate blood sugar. The head lies in the curve of the duodenum and is near many blood vessels. The body and tail extend to the left across the posterior abdomen. The pancreatic duct drains into the duodenum via one or two openings to aid digestion. Blood supply and lymphatic drainage involve several nearby vessels.
Pneumonia is an infection that inflames the lungs and causes symptoms like cough, fever, and difficulty breathing. It can be caused by bacteria, viruses, or fungi. Diagnosis involves chest x-rays, sputum tests, and blood tests. Treatment depends on the cause but may include antibiotics, oxygen therapy, or fluids. Complications can include lung abscesses or fluid in the chest. Vaccines can help prevent pneumonia.
This document discusses chronic obstructive pulmonary disease (COPD), which includes conditions such as chronic bronchitis and emphysema. COPD causes permanent damage to lung tissue and airways, resulting in inflammation and difficulty breathing. Approximately 16 million Americans have been diagnosed with COPD, with chronic bronchitis and emphysema being the most common conditions. Smoking is the primary cause of COPD, but air pollution and occupational exposures can also contribute to its development. The goals of COPD treatment are to slow lung function decline, relieve symptoms, and improve quality of life through medications, oxygen therapy, and smoking cessation.
Deciduous and permanent teeth Eruption time and sheddingAkram bhuiyan
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This document discusses the process of tooth eruption through various stages from development within the jawbone to functional positioning in the mouth. It describes three main stages of eruption: preeruptive within the bone, eruptive bringing the tooth through the gum, and posteruptive after it has reached the occlusal plane. The key theories discussed for what drives eruption include root growth, alveolar bone formation/remodeling, traction from the periodontal ligament, and vascular pressure within dental tissues. Experimental evidence suggests the dental follicle and subsequent periodontal ligament play important roles in directing eruption through their effects on surrounding bone.
development of root, Root formation and periodontal ligamentAkram bhuiyan
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The document describes the development of the dental pulp and root formation. It discusses how the dental pulp develops from mesenchymal cells that differentiate into odontoblasts. During the bell stage, the dental papilla forms and the cells within differentiate into odontoblasts and fibroblasts. The dental follicle surrounds the developing tooth structures. Root formation is guided by the Hertwig's epithelial root sheath, which determines the root morphology. Blood vessels and nerves enter the developing pulp. Cementum formation begins with primary acellular cementum laid down by cementoblasts. Secondary cellular cementum is later formed and incorporates cells.
morphology of maxillary & mandibular canine teethAkram bhuiyan
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This document describes the morphology of permanent canine teeth. It details the features of maxillary and mandibular canines, including their crowns, roots, and various aspects. The maxillary canine has a prominent cusp with sloping ridges, a bulky labial ridge, and the longest, strongest root. The mandibular canine is slightly narrower with a smoother lingual surface and shorter root. Key distinguishing features of canines are described for clinicians to identify their shape and position.
The document describes the morphology of maxillary premolars. The maxillary first premolar has two cusps, usually two roots, and erupts between ages 10-11 years. It resembles a canine in some features but has a longer mesial buccal cusp slope. The maxillary second premolar resembles the first but has a less pointed buccal cusp, shorter mesial buccal cusp ridge, and deeper distal developmental depression. It typically has one root and erupts between ages 10-12 years. Both premolars assist in tearing and chewing food.
1. The document discusses various common medical emergencies that may occur in a community setting and their management, including syncope, seizure, hypoglycemia, trauma, chest pain, airway obstruction, and asthma.
2. It provides guidance on assessing the situation, performing basic life support measures like opening the airway, giving oxygen, and positioning the patient, and determining if further definitive medical care is needed for stabilization or transfer to a hospital.
3. Emergency drug kits should contain medications for respiratory distress, cardiac issues, hypoglycemia, and more, with oxygen, epinephrine, nitroglycerin, bronchodilators, and glucagon being essential. Prompt recognition and appropriate first aid
morphology of maxillary 1st,2nd,3rd molar teethAkram bhuiyan
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This document describes the morphology of maxillary molars. It details the features of the crowns and roots seen from the buccal, lingual, mesial, distal and occlusal aspects. For the first maxillary molar, it notes the trapezoidal crown shape and cusps visible from each aspect. It also describes the number of roots, their morphology and bifurcation level. Dimensions of the first molar crown and roots are provided. The second molar is summarized as shorter with less developed distal cusps and similar roots. Considerable variation is noted in the smaller third molar which supplements the second molar.
morphology of Maxillary central and lateral incisors teethAkram bhuiyan
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This document summarizes the morphology of the maxillary central and lateral incisors. It describes the labial, lingual, mesial, distal, and incisal surfaces of the central incisor including developmental grooves, lobes, and cervical curvature. Dimensions are provided. The central incisor is the widest anterior tooth and has the most pronounced mesial cervical curvature. Eruption timing and root development are also outlined. For the lateral incisor, it notes they are smaller than centrals and have more rounded mesioincisal and distoincisal angles, as well as more prominent marginal ridges and cingulum lingually.
morphology of mandibular 1st,2nd premolar teethAkram bhuiyan
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This document describes the anatomical features of the mandibular first and second premolars. For the first premolar, it notes the presence of a large buccal cusp and smaller lingual cusp, as well as developmental grooves. The root has one root with a mesial groove. For the second premolar, it describes two common crown types - a 3-cusp and 2-cusp variation. The 3-cusp type has deep grooves forming a Y-shape and multiple fossae, while the 2-cusp type has a central groove. The root is larger and longer than the first premolar.
morphology of mandibular central and lateral incisors teethAkram bhuiyan
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This document discusses the morphology and anatomy of the mandibular central and lateral incisors. It describes the key features of each tooth, including their labial, lingual, mesial, distal, and incisal surfaces. The mandibular central incisor is the smallest tooth and has bilateral symmetry. It has sharp mesioincisal and distoincisal angles. The mandibular lateral incisor is slightly wider and has a more concave lingual fossa. Dimensions and eruption times of each tooth are also provided. The objectives are to identify the mandibular incisors and understand their morphology.
morphology of mandibular 1st,2nd,3rd molars teeth Akram bhuiyan
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Mandibular molars are the largest teeth in the lower jaw. The first molar has 5 cusps and 2 roots, while the second molar has 4 cusps. The third molar shape and size varies greatly. Key features include developmental grooves separating cusps, marginal ridges, central fossa and pit. The first molar is largest, second molar slightly smaller, and third molar size varies but is generally the smallest with poorly formed roots.
This document provides information on cementum, including its definition, physical characteristics, chemical composition, formation (cementogenesis), classification, functions, anomalies, and clinical considerations. Cementum is the mineralized tissue covering tooth roots. It is softer than dentin and lacks enamel's luster. Cementum formation involves acellular and cellular stages. Cementum attaches the periodontal ligament fibers to the tooth root and allows for tooth repair. Abnormalities include hypercementosis, ankylosis, and cementomas. Cementum is an important part of the periodontium that aids in tooth attachment and repair.
The key aging changes that occur in the dental hard tissues include increased attrition and discoloration of enamel, as well as increased formation of dead tracts, sclerotic dentin, and reparative dentin in the dentin. Cementum may exhibit hypercementosis, cementicles, and decreased permeability with age. The major change in alveolar bone is resorption, leading to decreased height and width of the jaws, increased distance between the alveolar crest and teeth, and an uneven appearance of alveolar sockets.
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
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These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
How to Manage Reception Report in Odoo 17Celine George
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A business may deal with both sales and purchases occasionally. They buy things from vendors and then sell them to their customers. Such dealings can be confusing at times. Because multiple clients may inquire about the same product at the same time, after purchasing those products, customers must be assigned to them. Odoo has a tool called Reception Report that can be used to complete this assignment. By enabling this, a reception report comes automatically after confirming a receipt, from which we can assign products to orders.
This presentation was provided by Racquel Jemison, Ph.D., Christina MacLaughlin, Ph.D., and Paulomi Majumder. Ph.D., all of the American Chemical Society, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
A Free 200-Page eBook ~ Brain and Mind Exercise.pptxOH TEIK BIN
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(A Free eBook comprising 3 Sets of Presentation of a selection of Puzzles, Brain Teasers and Thinking Problems to exercise both the mind and the Right and Left Brain. To help keep the mind and brain fit and healthy. Good for both the young and old alike.
Answers are given for all the puzzles and problems.)
With Metta,
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THE SACRIFICE HOW PRO-PALESTINE PROTESTS STUDENTS ARE SACRIFICING TO CHANGE T...indexPub
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The recent surge in pro-Palestine student activism has prompted significant responses from universities, ranging from negotiations and divestment commitments to increased transparency about investments in companies supporting the war on Gaza. This activism has led to the cessation of student encampments but also highlighted the substantial sacrifices made by students, including academic disruptions and personal risks. The primary drivers of these protests are poor university administration, lack of transparency, and inadequate communication between officials and students. This study examines the profound emotional, psychological, and professional impacts on students engaged in pro-Palestine protests, focusing on Generation Z's (Gen-Z) activism dynamics. This paper explores the significant sacrifices made by these students and even the professors supporting the pro-Palestine movement, with a focus on recent global movements. Through an in-depth analysis of printed and electronic media, the study examines the impacts of these sacrifices on the academic and personal lives of those involved. The paper highlights examples from various universities, demonstrating student activism's long-term and short-term effects, including disciplinary actions, social backlash, and career implications. The researchers also explore the broader implications of student sacrifices. The findings reveal that these sacrifices are driven by a profound commitment to justice and human rights, and are influenced by the increasing availability of information, peer interactions, and personal convictions. The study also discusses the broader implications of this activism, comparing it to historical precedents and assessing its potential to influence policy and public opinion. The emotional and psychological toll on student activists is significant, but their sense of purpose and community support mitigates some of these challenges. However, the researchers call for acknowledging the broader Impact of these sacrifices on the future global movement of FreePalestine.
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4. Also, The abdomen is divided into 9 regions by:
ď§2 lateral vertical planes; passing from the mid-clavicular
lines, continued downwards, to the mid-point between the
anterior superior iliac spine and the pubic symphysis (right
and a left lateral line drawn vertically through points halfway
between the anterior superior iliac spines and the middle
line).
ď§2 horizontal planes; the subcostal (passing across the
abdomen to connect the lowest points on the costal margin);
and the interiliac (passing across the abdomen to connect the
tubercles of the iliac crests)
10. Inspection of the Anterior Abdominal Wall
Inspection of mid-line
from above downward
Inspection of the sides
1- Subcostal angle
2- Epigastric pulsation
3- Divarication of recti
4- Umbilicus
5- Suprapubic hair distribution
6- Hernial orifices
1- Contour of the abdomen
2- Collateral (dilated veins)
3- Skin
4- Scars
5- Movement with respiration
6- Visible peristalsis
11.
12.
13.
14.
15. III. Hernia
ď§ Expansile impulse in cough
IV. Dilated veins
ď§ Caput medusa in portal hypertension
V. Skin
ď§ Pigmentation around umbilicus (T.B. peritonitis, Addison dis.)
ď§ Nodules âsister Mary-Joseph nodulesâ (abd. malignancy)
ď§ Ecchymosis âCullen's signâ (hemorrhagic pancreatitis and
internal hemorrhage)
VI. Discharge:
ď§ Pus ď inflammation
ď§ Stool ď intestinal fistula
ď§ Urine ď patent urachus
21. ⢠examination of abdominal
contours
â Standing at the foot of the table
â Lower yourself until the anterior
abdominal wall
â ask the patient to breathe
normally while you are inspect
the abdomen.
22. Generalized abdominal
distension
Localized abdominal
distension
1- Fluid (ascites)
2- Fat (obesity)
3- Flatus and Faeces
4- Foetus (pregnancy)
5- Full urinary bladder
1- Site
2- Shape and size
3- Pulsate on cough (hernia
or not)
4- Movement with
respiration
5- Extra-abdominal or Intra-
abdominal (by asking the pt.
to sit up in bed unsupported)
25. IVC obstruction Portal vein obstruction
1- Site of
collaterals
Laterally (Sides) Around umbilicus (caput
medusa)
2- Blood
flow
From below upwards
âtowards the headâ
(to bypass the
obstructionď the blood
bypass the IVC via
abdominal wall veins to
the thorax)
Away from the
umbilicusâtowards the legsâ
(the blood pass from the left
branch of portal vein to para
umbilical vein to anterior
abdominal wall veins through
the umbilicus)
3- cause in
hepatic Pt
Functional compression
on IVC by tense ascites
Intra-hepatic causes of portal
hypertension
26. Methods of Detection
- The 2 index fingers of both hands are used to milk the blood
away from one segment of a dilated veinď then, applying
firm pressure on both ends of the segment ď the fingers
then can be lifted one by one, while observing the rate of
filling at which the vein fills from each directionď the blood
will be seen coming more rapidly from the direction of blood
flow.
28. Caput medusae accentuated by marked ascites.
An extensive plexus of veins is seen radiating from the umbilical region
and radiating across the anterior abdominal wall. Note the large vein
coursing inferiorly along the right flank (arrows). This is the superficial
epigastric vein.
29.
30.
31.
32.
33. It is often difficult to understand whether tiny red spots arising on skin
surface are Petechiae or Purpura. However, Petechiae spots have a very
small diameter that is maximum 3 mm in size. Purpura rashes are larger
in size. These have a diameter that is about 5 mm. A spot that is bigger
than Purpura is known as common bruise or echymosis
Echymosis
Abdominal
petichae
42. Normally palpable structures
1. Contracted muscles of abdominal wall in muscular persons
2. Colon (caecum and sigmoid) is felt when it is spastic (full of gas or
fluid)
3. Vertebra (L4 â L5)
4. Pulsations of abdominal aorta (usually felt below the umbilicus)
in thin persons
5. Lower pole of Rt. Kidney (especially in female with thin lax
abdominal wall)
6. Liver edge descends 1-3 cm below the costal margin on deep
inspiration, but the consistency is soft and difficult to feel.
7. Occasionally, a tongue-like process (reidelâs lobe) is felt (which is
an anatomical variation of the Rt. lobe), moves with respiration
44. For:
-Confidence of the patient
-Superficial masses
-Tenderness
-Rigidity
-Temperature
âfrom the Lt. iliac fossa ď in anticlockwise directionď
till the suprapubic areaâ
Superficial Palpation
45. ⢠Technique
â Use pads of three fingers (palmar surface of fingers) of
one hand and a light, gentle, dipping maneuver to
examine abdomen
â Abdominal wall depressed approximately 1 cm
48. Deep Palpation
For :
-Organs âliver, spleen, gall bladder, kidney, colon, urinary
bladderâ
- Masses (ask the patient to flexes his neck as this contracts rectus muscles)
-Areas of deep tenderness and rebound (pain induced or
increased by letting go)
Deep palpation include the following methods
-Ordinary technique âclassicâ
-2 handed method
-Bimanual
-Dipping
-Hooking
-Rolling
49. ⢠Technique
â Entire palm (use palmar surface of fingers of one hand; greatest
number of fingers) and a deep, firm, gentle maneuver to examine
abdomen
â Either one- or two handed technique is acceptable (When deep
palpation is difficult, examiner may want to use left hand placed
over right hand to help exert pressure)
â Palpate tender areas last
â Palpate deeply with finger pads (do not âdig inâ with finger tips)
â Abdominal wall depressed around 4 cm or Push as deeply as
patient will allow without significant discomfort.
55. ď§ The spleen is not normally palpable
ď§ It has to be enlarged 2-3 times its usual size to be palpable
under the subcostal margin
ď§ Enlargement occurs superiorly and posteriorly before it
becomes palpable subcostaly
ď§ Once the spleen has appeared in this situation, the
direction of further enlargement is downward and towards
the Rt. Iliac fossa
ď§ The spleen which is not felt doesnât exclude splenomegaly
but it can be said that the spleen is not felt
56. Methods of Deep Palpation
ď§ Classical method (single-handed method)
ď§ Two handed method
ď§ Bimanual examination
- in the supine position - in the Rt lateral position)
ď§ Dipping method
ď§ Hooking method
62. With the patient in the right lateral position, minimal splenic
enlargement can be detected
Palpating the spleen â Bimanual palpation in
Rt. Lateral position
65. Examining for the spleen from behind the patient, in the right
lateral position. In this case, the fingers are "hooked" over the
costal margin.
Hooking method
66. Nature of this palpable spleen (put a comment on):
1. Size
ď§ Mild (just palpable to 5cm)
ď§ Moderate (5 â 10 cm)
ď§ Huge (more than 10 cm, below the umbilicus)
2. Border
3. Surface
4. Consistency
5. Tenderness (e.g. due to splenic infarction, septicemia,
SBE)
67. Applied anatomy and physiology of the spleen
ď§The spleen is composed predominantly of lymphoid and R.E. tissues,
so, any condition âinfectious; immunologic; metabolic; malignant or
idiopathicâ that causes hyperplasia of the lymphoid/RES may cause
splenomegaly
ď§The spleen is expansile organ containing many sinusoids, so,
interference with its venous drainage as in portal hypertension will
cause splenomegaly âcongestive splenomegalyâ
ď§The spleen is a blood forming organ in fetal life and a potential blood
forming organ throughout life, so, in myelosclerosis and myelofibrosis,
extramedullary hematopoiesis may occur in the spleen with
splenomegaly
ď§The spleen destroys senile and defective RBCs, so, in hemolytic
anemias, this function is increase with splenomegaly âexcept in sickle
cell anemiaâ
68. Causes of Huge Spleen (below the umbilicus)
ď§ Bilharzial splenomegaly
ď§ Kala azar âvisceral leishmaniasisâ
ď§ Chronic malaria causing TSS âTropical splenomegaly syndromeâ
ď§ CML
ď§ Myelofibrosis and Myelosclerosis
ď§ Polycythemia rubra vera
ď§ Beta-thalassemia major
ď§ Amyloidosis
ď§ Gaucherâs disease
69. Hypersplenism
- Whenever the spleen is enlarged, hypersplenism may occur
-It is characterized by
ď§ Pancytopenia in the peripheral blood (Normocytic
normochromic anemia, neutropenia, thrombocytopenia in
the CBC) due to hyperfunction of the spleen
ď§ One element or two may be decreased only
ď§ B.M examination: hypercellular or normal
ď§ CR-51 labelled RBCs and platelets
ď§ Splenectomy returns the CBC to normal
70. Characters of splenic swelling to be differentiated
from the Lt. kidney
-By inspection ď Moves with respiration down and medially
-By palpation ď it has a notch on the lower part of the anterior
(upper) border âPATHOGNOMONICâ
ď hand can't be insinuated between the mass and the
costal margin to get above its upper pole
ď negative ballottement (canât be pushed in the renal
angle)
-By percussion ď dull on percussion and continuous with the splenic
dullness
71.
72.
73. Upper border is marked by joining the following points:
1st
pointď Lt. 5th
intercostal space in the MCL âapex of the heartâ
2nd
point ď Xiphisternal joint.
3rd
point ď Upper border of 5th
rib in Rt. MCL
4th
point ď 7th
rib at RT MAL.
5th
point ď 9th
rib at RT scapular line.
Lower border is marked by curved line joining the following points:
1st
pointď Lt. 5th
intercostal space in the MCL âapex of the heartâ
2nd
point ď 8th
costal cartilage in the Lt. parasternal line.
3rd
point ď midway between xiphisternal junction and the umbilicus
4th
point ď 9th costal cartilage in the Rt. MCL.
5th
point ď 10th
rib in the Rt. MAL.
6th
point ď 12th
rib in Rt. Scapular line
76. Technique of detecting the liver
ď§ Upper border is detected by heavy percussion âhepatic
dullnessâ
ď§ Lower border is detected by deep palpation and light
percussion
After palpation of the lower border of the liver, you must
comment on
I. Liver span : Distance between the upper and lower
borders of the liver; which is
ďś4 â 8 cm in the middle line ârepresents the Lt.
lobeâ
ďś9 â 14 cm in the Rt. MCL ârepresents the RT.
lobeâ
77. II.Nature of this palpable liver (put a comment on):
1. Size âin finger breadth or cmâ
ď§ Normally: not felt below the costal margin
ď§ Abnormally: enlarged âcauses of hepatomegalyâ or shrunken
âliver cirrhosis and fibrosisâ
2. Surface
ď§ Normally: smooth
ď§ Abnormally:
- smooth âcongestion, inflammation, infiltrationâ
- fine irregular âcirrhosisâ
- nodular âmalignancyâ
2. Edge
ď§ Normally: sharp
ď§ Abnormally:
- sharp âcirrhosis, fibrosisâ
- rounded âcongestion, inflammation, infiltrationâ
79. Methods of Palpation
ď§ Classical method (single-handed palpation)
ď§ Two-handed method
ď§ Bimanual examination
ď§ Dipping method
ď§ Hooking method
- Single-handed palpation is used for lean individuals, while the
bimanual technique is best for obese or muscular individuals. Using
either technique, the liver is felt best at deep inspiration.
80. Single-handed
method
- For single-handed palpation, the examiner's right hand is initially placed on the
patient's abdomen in the right lower quadrant and parallel to the rectus muscle in
the MCL. This is done so that palpation of the rectus is not confused with palpation
of the underlying and adjacent liver
- Gently pressing in and up, ask the patient to take a deep breath.
ď§ Palpating hand is held steady while patient inhales
ď§ Palpating hand is lifted and moved while the patient breathes out
ď§ If the liver is enlarged, it will come downward to meet your fingertips and will
be recognizable.
81. ď§ Another method of palpating the liver uses the radial border of the
index finger. In this method the anterior hand is placed flat on the
anterior abdominal wall with fingers parallel to the costal margin
82. the left hand is held posteriorly,
between the 12th
rib and the iliac crest.
It is lifted gently upward to elevate the
bulk of the liver into a more easily
accessible position, while the right
hand is held anterior and lateral to the
rectus musculature. The right hand
moves upward using gentle, steady
pressure until the liver edge is felt.
Bimanual palpation
of Liver
84. â Is useful when the
patient is obese or
when the examiner is
small compared to the
patient.
â Stand by the patient's
chest.
â "Hook" your fingers
just below the costal
margin and press
firmly.
Hooking method
86. Causes of ptosed liver
ď§ Emphysema
ď§ Pneumothorax
ď§ Pleural effusion
ď§ Subphrenic abscess
Causes of upward displacement of the liver
ď§ Lung fibrosis/collapse
ď§ Diaphragmatic paralysis
ď§ Ascites / abdominal tumours
87. Percussion is a method of tapping on a surface to determine the
underlying structure
88. Technique
-It is done with the middle finger of Rt. hand (plexor) tapping on DIP of
the middle finger of the Lt. hand (pleximeter) using a wrist action.
-The non striking finger (pleximeter) is placed firmly on the abdomen,
remainder of hand not touching the abdomen.
-Remember that it is easier to hear the change from resonance to
dullness â so proceed with percussion from areas of resonance to areas
of dullness.
pleximeter
plexor
89. There are two basic sounds
â Resonant sounds indicates hollow, air-filled structures. The
abdomen gives resonant note which varies according to the
amount of gas present in the intestine.
â Dull sounds indicates the presence of a solid structure (e.g. liver)
or fluid (e.g. ascites) lies beneath the region being examined
90. Percussion of the abdomen
-The abdomen gives a resonant note which varies according to the
amount of gas present in the intestine
-Type of percussion: Light percussion
-Values:
ď§ Deleneation of borders of abdominal organs (& assessing for
organomegaly).
ď§ Decetction of ascites
ď§ Detection of gaseous distension âtympanic resonant noteâ
ď§ Detection of acute abdomen (obliteration of normal liver
dullness) in;
- Perforated peptic ulcer and colon
- Subphrenic abscess with gas forming organisms
91. ⢠The two solid organs which are
percussable in the normal
patient
â Liver: will be entirely covered by
the ribs.
â Spleen: The spleen is smaller and
is entirely protected by the ribs.
92. Percussion âliverâ
Upper border ď by deep percussion
Lower border ď by light percussion
Upper border
ď§ Define the sternal angle âangle of Louisâ (2nd
rib), then start
percussing the 2nd
intercostal space in the Rt. MCL (Start just
below the Rt. breast in RT. MCL). Percussion in this area should
produce a relatively resonant note
ď§ Percussing in the chest moving down towards the abdomen
about ½ to 1 cm at a time (in the intercostal spaces).
ď§ Note where the percussion notes change from resonant to dull.
ď§ The normal hepatic dullness will be reached at the 5th
intercostal
space in the RT. MCL
Lower border
ď§ Begin percussion below the umbilicus, in the Rt. MCL and
proceed upward until dullness is encounter.
93. The liver span is estimated by percussion
The distance between the two areas where dullness is first encountered is the liver span.
96. Traube's area
ď§It is a semilunar (crescent)-shaped area
ď§It is area of tympanic resonance overlying the fundus of stomach
ď§Boundaries
ďUpper borderď lower border of Lt. lung (convex line from the Lt.
6th
rib in MCL to the Lt 9th
rib in mid-axillary line)
ďRight borderď Lateral margin of left lobe of liver (from Lt. 6th
rib
in MCL to the Lt. 8th
costal cartilage)
ďLeft borderď anterior border of the spleen (Lt. 9-11 spaces in
mid-axillary line)
ďLower borderď Lt. costal margin (from the Lt. 8th
costal cartilage
to Lt. 11th
space in mid-axilary line )
97.
98. ď§ Causes of dullness of Traubeâs area:
1. Full stomach/ gastric tumours.
2. Left sided Pleural effusion / pericardial effusion âfrom aboveâ.
3. Ascites/abdominal tumour âfrom belowâ
4. Splenomegaly âfrom left sideâ.
5. Enlargement of left lobe of liver âfrom the right sideâ.
99. Castellâs method âSplenic percussion signâ
ď§Put the patient in the supine position
ď§Left anterior axillary line identified
ď§Left lower costal margin identified
ď§ Percuss in the lowest Left intercostal space in the anterior axillary
line (usually the 8th or 9th IC space) while patient inhales and
exhales deeply
ď§This space should remain resonant during full inspiration
ď§Dullness on full inspiration indicates possible splenic enlargement (a
positive Castellâs sign)
102. Nixonâs method
ď§Place the patient in Right lateral decubitus
ď§Begin percussion midway along the Left costal margin
ď§Proceed in a line perpendicular to the Left costal margin
ď§If the upper limit of dullness extends >8 cm above the Left costal
margin, this indicates possible splenomegaly
103. Ascites is free collection of fluid within the peritoneal cavity.
The classical signs of ascites include; abdominal distension, shifting
dullness, fluid thrill.
ď§Minimal ascites ď detected in the knee elbow position
ď§Moderate ascites ď detected by the bilateral shifting dullness
ď§Tense ascites ď detected by transmitted fluid thrill âfluid waveâ
104. Bilateral shifting dullness
1.The patient is examined in the supine position.
2.Percussion is done over the abdomen, from the umbilicus to one flank.
3.The spot of the transition from tympany to dullness is detected.
4.The patient is then turned to the opposite side, while the examiner keeps his
hand unmoved.
5. Percussion of the same spot (which is top now) gives a tympanic note.
Note: The tympany over the umbilicus occurs in ascites because bowel floats
to the top of the abdominal fluid.
air
air
fluid
fluid
105. Transmitted fluid thrill
Pathognomonic foe ascites when the amount of fluid is large
1.The patient is examined in the supine position.
2.The patient or an assistant places one hand in the midline and
presses firmly with the ulnar border of the hand , so cut off any
vibrations transmitted by the abdominal wall.
3.The examiner places one palm on one flank, while giving a sharp tap
with the finger tips on the opposite flank.
4.Positive test: a definite wave âimpulseâ will be distinctly felt by the
receiving hand.
106.
107. ⢠Diaphragm of stethoscope used
⢠Skin depressed to approximately 1 cm
⢠Listening in one spot is usually sufficient
⢠Listening for 15-20 or 30-60 seconds
108. Values of auscultation
1.To hear intestinal sounds ď characteristic gurgling bubbling (gas and
fluid in intestine) sounds.
ď Increase in: acute diarrhea (âmotility) and in early intestinal
obstruction
ď Absent in: paralytic ileus
N.B. Bowel sounds cannot be said to be absent unless they are
not heard after listening for 3-5 minutes.
109. 2. To hear vascular sounds
Arterial bruit Venous hum
(Wind at sea shore)
Systolic murmur Systolic and diastolic sound in the
epigastrium, and Lt. hypochondrial
region âKenawy signâ
Occurs in cases of
-Abdominal aortic aneurysm
-Renal artery stenosis
-Over very vascular tumour
âe.g. hemangiomaâ
Occurs in cases of
- portal hypertension due to porto-
systemic anastomosis (collateral)
110. 3. Friction rub ď
a dry, grating sound heard with a stethoscope during auscultation; may
be heared over enlarged liver or spleen
ď§ Splenic rub: in Lt. hypochondrium; due to splenic infarction and
perisplenitis
ď§ Hepatic rub: in Rt. Hypochondrium; due to hepatic malignancy
with perihepatitis (inflammatory changes or infection in or
adjacent to the liver). If detected in a young woman, the
examiner should consider gonococcal peritonitis of the upper
abdomen (FitzâHughâCurtis syndrome).
N.B. A hepatic rub and bruit in the same patient usually indicates
cancer in the liver. A hepatic rub, bruit, and abdominal venous
hum would suggest that a patient with cirrhosis had developed a
hepatoma.
111. 4. To detect lower border of the liver (scratch method)
ď§ Place the diaphragm over the area of the liver ď scratch parallel to
the costal margin in MCLď When the liver is encountered, the
scratching sound heard in the stethoscope will increase significantly
5. To detect minimal ascites (Puddleâs sign)
It is useful for detecting small amounts of ascites (as small as 120 mL;
shifting dullness and bulging flanks typically require 500 mL).
The steps are outlined as follows:
ď§ Patient lies prone for 5 minutes
ď§ Patient then rises onto elbows and knees
ď§ Apply stethoscope diaphragm to most dependent part of the abdomen
ď§ Examiner repeatedly flicks near flank with finger.
ď§ Continue to flick at same spot on abdomen
ď§ Move stethoscope across abdomen away from examiner
ď§ Sound loudness increases at farther edge of puddle
112. Scratch Test
Start in the same areas
above and below the
liver as you would with
percussion. Instead of
percussing lightly,
scratch moving your
finger back and forth
while listening over the
liver. Since sound is
conducted better in
solids than in air, when
the louder sounds are
heard you are over the
liver. Mark the superior
and inferior boarders of
the liver span in the
midclavicular line
113. 6. Succusion splash ď in case of pyloric obstruction (distended
stomach with gas and fluid)
ď§ placing the stethoscope over the upper abdomen ď rocking the
patient back and forth at the hips ď Retained gastric material >3
hours after a meal will generate a splash sound.
7. To detect pregnancy ď fetal heart sounds.
Editor's Notes
Palpation: Lightly, all 4 quadrants
Palpate lightly in all 4 quadrants. Press down around 1 cm. Remember to look at the patientâs face during palpation to see if any tenderness is elicited.
Palpation: Deeply, all 4 quadrants
One should use two hands. Press down around 4 cm
132-133: Palpation: Spleen
Palpation: Spleen (attempts to do)
Palpation: Spleen (correctly - position, breaths, palpating deepest full inspiration, 1 hand under L side, 1 feeling)
Palpation: Spleen (if not palpable, R lateral decubitus)
Palpation of Spleen:
Right lateral decubitus.
127:Percussion: Liver span
The liver span is estimated by percussion.
Remember that it is easier to hear the change from resonance to dullness â so proceed with percussion from areas of resonance to areas of dullness.
Upper border: In the midclavicular line start percussing in the chest moving down towards the abdomen about ½ to 1 cm at a time. Note where the percussion notes change from resonate to dull.
Lower border: In the midclavicular line begin percussion below the unbillicus and proceed upward until dullness is encounter.
The distance between the two areas where dullness is first encountered is the liver span.
Liver span is normally 6 to 12 cm in the midclavicular line.
Liver Span: May Do Scratch Test
If you are unable to determine liver span by percussion then the scratch test may be used. Start in the same areas above and below the liver as you would with percussion. Instead of percussing lightly scratch moving your finger back and forth while listening over the liver. Since sound is conducted better in solids than in air, when the louder sounds are heard you are over the liver. Mark the superior and inferior boarders of the liver span in the midclavicular line