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Abdominal Exam Techniques
- 1. ABDOMINAL EXAMINATION Jimma university medical center Department of Internal medicine Dr. Haftu z.(IMr1) 24/6/2015 E.C. 8/22/2023 1 Abdomen
- 2. outline • Basic anatomy • Presenting complaints • Preparations • Inspection • Auscaltation • Percussion • Palpation 8/22/2023 2 Abdomen
- 6. Presenting complaints Gastrointestinal Disorders • Indigestion or anorexia • Nausea, vomiting, or hematemesis • Abdominal pain • Dysphagia and/or odynophagia • Change in bowel function • Constipation or diarrhea • Jaundice Urinary and Renal Disorders • Suprapubic pain Dysuria, urgency, or frequency • Hesitancy, decreased stream in males • Polyuria or nocturia • Urinary incontinence • Hematuria • Kidney or flank pain • Ureteral colic 8/22/2023 6 Abdomen
- 8. Preparation • Empty bladder • supine position,pilow and slide your hand through the back • Hands in side or folded across the chest • Exposure from the nipple to the mid-thigh; suprapubic area • Ask for any site of pain before you start palpation • warm your hand and stethoscope,avoid long finger nail • Approach slowly and avoid quick unexpected movements 8/22/2023 8 Abdomen
- 9. Inspection 1. SKIN • Scar • Striae- Old silver striae or stretch marks-normal Pink–purple striae of Cushing’s syndrome • dilated veins- cirrhosis(away from the umblicus),inferior STRIAE MARKING 8/22/2023 9 Abdomen
- 10. 2. Abdominal contour and umblicus Abdominal contour • protuberent • flat • scaphoid • flank buldging or any site • visible mass • symmetry Umblicus • normaly-inverted 8/22/2023 10 Abdomen
- 11. 3. Visible pulsation and peristalsis pulsation • it could be visible in the epigastrium • aortic aneurysm or high pulse pressure peristalsis • visible in normal and slim individual • intestinal obstruction 8/22/2023 11 Abdomen
- 12. 4. Cough impulse test • Ask patient to cough and check for possible hernia in the inguinal and femoral area 8/22/2023 12 Abdomen
- 13. Auscultation • Bowl sound- 5-34/min • Bruits -Bruits with both systolic and diastolic components suggest the turbulent blood flow of partial arterial occlusion • Venous hum-cirrhosis • friction rub- spleen and liver tumor,infarction,gonococcal 8/22/2023 13 Abdomen
- 14. Percussion Perussion notes • tympanic • hypertympanic • dull liver span- normal 6-12 cm- @MCL shifting dullness fluid thrill 8/22/2023 14 Abdomen
- 15. palpation superficial palpation • rigidty • tenderness • mass maneuvers to release voluntary rigidty breathing jaw dropped flexing the leg at knee 8/22/2023 15 Abdomen
- 16. Deep palpation • delineate size of mass • delineate size of an organ • deep tenderness of peritoneal irritation direct rebound right fist tap for liver 8/22/2023 16 Abdomen
- 18. Spleen • When a spleen enlarges, it expands anteriorly, downward, and medially • Percussion cannot confirm splenic enlargement but can raise your suspicions of it. • Palpation can confirm the enlargement, but often misses large spleens that do not descend below the costal margin,it could be palpable in 3%. 8/22/2023 18 Abdomen
- 19. palpation • sensitivity-56–71% • different way of palpationtechnique plapation from the rilower quadrant along the line of growth middlton maneuver- from up-down bimanual palpation 8/22/2023 19 Abdomen
- 20. percussion • Sensitivity 59–82% for percussion • different maneuvers Nixon’s method The patient is placed on the right side so that the spleen lies above the colon and stomach. Percussion begins at the lower level of pulmonary resonance in the posterior axillary line and proceeds diagonally along a perpendicular line toward the lower midanterior costal margin. The upper border of dullness is normally 6–8 cm above the costal margin. Dullness >8 cm in an adult is presumed to indicate splenic enlargement. 8/22/2023 20 Abdomen
- 22. Castell’s method • With the patient supine, percussion in the lowest intercostal space in the anterior axillary line (8th or 9th) produces a resonant note if the spleen is normal in size. • This is true during expiration or full inspiration. • A dull percussion note on full inspiration suggests splenomegaly. 8/22/2023 22 Abdomen
- 24. Percussion of Traube’s semilunar space The borders of Traube’s space • are the sixth rib superiorly, • the left midaxillary line laterally, and • the left costal margin inferiorly. The patient is supine with the left arm slightly abducted. During normal breathing, this space is percussed from medial to lateral margins, yielding a normal resonant sound. A dull percussion note suggests splenomegaly. 8/22/2023 24 Abdomen
- 26. Kidney BIMANUAL PALPATION TENDERNESS 8/22/2023 26 Abdomen
- 27. Appendicitis and peritonitis • Rovsing sigh • Psoas sign • Obturator sign 8/22/2023 27 Abdomen
- 28. Reference • Bate’s guid to physical examination • Harisson’s textbook of internal medicine 21st edition 8/22/2023 28 Abdomen