006 The Abdomen - Introduction to Clinical Surgery Lectures

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Lecture on the abdomen from a series of lectures on an introduction to clinical surgery. It has been devised with medical students in mind.

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006 The Abdomen - Introduction to Clinical Surgery Lectures

  1. 1. The Abdomen Nick Harvey
  2. 2. The Abdomen: History <ul><li>Appetite </li></ul><ul><li>Loss of weight </li></ul><ul><ul><li>How much? How quickly? </li></ul></ul><ul><li>Dysphagia </li></ul><ul><ul><li>Solids, fluids </li></ul></ul><ul><li>Heartburn </li></ul><ul><li>Vomiting </li></ul><ul><ul><li>How often? Nature? Relation to eating? Certain time? Bile stained? Blood stained (haematemesis)? </li></ul></ul>
  3. 3. The Abdomen: History <ul><li>Indigestion </li></ul><ul><li>Abdominal pain </li></ul><ul><li>Abdominal distension </li></ul><ul><li>Bowel habit </li></ul><ul><ul><li>Change </li></ul></ul><ul><ul><li>Colour </li></ul></ul><ul><ul><li>Consistency </li></ul></ul><ul><li>PR blood </li></ul><ul><ul><li>Bright or dark red </li></ul></ul><ul><ul><li>Pan or paper </li></ul></ul><ul><ul><li>Mixed or coating </li></ul></ul><ul><li>PR Mucous </li></ul>
  4. 4. The Abdomen: History <ul><li>Melaena </li></ul><ul><li>Jaundice </li></ul><ul><li>Itching </li></ul><ul><li>Colour or urine/stools </li></ul><ul><li>Fever </li></ul><ul><ul><li>Relation to symptoms </li></ul></ul>
  5. 5. The Abdomen: General Examination <ul><li>Hands </li></ul><ul><ul><li>Nails, Palms, Pulse </li></ul></ul><ul><li>Eyes </li></ul><ul><ul><li>Conjunctiva, sclera, cornea </li></ul></ul><ul><li>Virchow’s node </li></ul><ul><li>Chest </li></ul><ul><ul><li>Gynaecomastia, spider naevi, excoriation marks </li></ul></ul>
  6. 6. The Abdomen: Local Examination <ul><li>Position </li></ul><ul><ul><li>Supine </li></ul></ul><ul><li>Exposure </li></ul><ul><ul><li>“Nipples to knees” </li></ul></ul>
  7. 7. The Abdomen: The Regions
  8. 8. The Abdomen: Inspection <ul><li>Shape </li></ul><ul><li>Size </li></ul><ul><li>Scars (remember flanks & groins) </li></ul><ul><li>Skin lesions </li></ul><ul><li>Stoma </li></ul><ul><li>Dilated veins </li></ul><ul><li>Pulsations </li></ul><ul><li>Hernias (remember groins) </li></ul><ul><li>Divarication </li></ul>
  9. 9. The Abdomen: Palpation <ul><li>Superficial </li></ul><ul><ul><li>For tenderness & rigidity </li></ul></ul><ul><li>Deep </li></ul><ul><ul><li>For masses </li></ul></ul><ul><li>Organs </li></ul><ul><ul><li>Liver </li></ul></ul><ul><ul><li>Spleen </li></ul></ul><ul><ul><li>Kidneys </li></ul></ul><ul><ul><li>Aorta </li></ul></ul>
  10. 10. The Abdomen: Signs of Hepatomegaly <ul><li>Descends from below the right costal margin and costal angle </li></ul><ul><li>You cannot get above it </li></ul><ul><li>Moves with respiration </li></ul><ul><li>Edge (sharp or rounded) </li></ul><ul><li>Surface (smooth or irregular) </li></ul><ul><li>Dull to percussion to the 8 th rib in the mid-axillary line </li></ul>
  11. 11. The Abdomen: Signs of Enlarged Gallbladder <ul><li>Appears from beneath the tip of the right 9 th rib </li></ul><ul><li>Smooth and hemi-ovoid </li></ul><ul><li>Moves with respiration </li></ul><ul><li>No space between the lump and the liver </li></ul><ul><li>Dull to percussion </li></ul>
  12. 12. The Abdomen: Signs of Splenomegaly <ul><li>Appears from below the left 10 th rib and enlarges alongside this rib towards the umbilicus </li></ul><ul><li>Firm with smooth surface and rounded edge </li></ul><ul><li>Notch </li></ul><ul><li>Can’t get above it </li></ul><ul><li>Dull to percussion </li></ul><ul><li>Can’t be balloted </li></ul>
  13. 13. The Abdomen: Signs of Enlarged Kidney <ul><li>Lies in the loins </li></ul><ul><li>Moves with respiration </li></ul><ul><li>Can be balloted </li></ul><ul><li>Resonant to percussion (covered by colon) </li></ul>
  14. 14. The Abdomen: Signs of a AAA <ul><li>Above the umbilicus </li></ul><ul><li>Expansile </li></ul><ul><li>Estimate size </li></ul><ul><li>If pulsation below - iliacs </li></ul>
  15. 15. The Abdomen: Percussion & Auscultation <ul><li>Percussion </li></ul><ul><ul><li>Masses </li></ul></ul><ul><ul><li>Fluid </li></ul></ul><ul><li>Auscultation </li></ul><ul><ul><li>Bowel sounds </li></ul></ul><ul><ul><li>Vascular bruit </li></ul></ul>
  16. 16. The Abdomen: Don’t forget to examine <ul><li>Back </li></ul><ul><li>External genetalia </li></ul><ul><li>DRE </li></ul><ul><li>Urine dip & β HCG </li></ul>

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