Examination of Abdomen by UG students.

1. Examination of Abdomen
Dr Santosh Kumar Singh
Assistant Professor
Department of Pediatrics
18.02.2019

2. 1.Right
hypochondrium:
Liver, gallbladder
and large colon
3.Left hypochondrium:
Spleen, colon
2. Epigastrium:
Stomach, pancreas,
left lobe of liver
4.Right lumbar:
Right kidney, large
colon 6.Left lumbar: Left
kidney, large colon
5 Umbilical: Small
intestine
7 .Right iliac:
Large bowel
8.5uprapubic:
Urinary bladder
9.Left iliac: large
bowel,rectum
Contents of 9 Regions of Abdomen

4. General Examination Relevant to Abdomen
1. Jaundice
2. Pallor -anaemia
3. Lymphadenopathy- TB, leukemia, lymphoma
5. Signs of liver cell failure- jaundice, palmer erythema,
6. Edema and dehydration
7. Clubbing
9. Bony tenderness
10.Nutritional status
11.Eye & Oral cavity

5. Examination of the Abdomen-position
Examining an infant in the mother’s lap toddler in standing position.

6. A. Inspection of the Abdomen
1.Shape of the abdomen-fullness, protuberant,
localized distension, scaphoid abdomen
2.Abdominal movements
3.Umbilicus: Position and shape everted, hernia
4.Skin scars or incision
5.Superficial dilated veins- blood flow direction.
6.Visible peristalsis
7.Groins and scrotum

7. B. Palpation
• Ask the child to lie supine with the hip joints
flexed and arms by the side.
• Ask the child to relax.
• Position your forearm horizontally along
the abdomen and place the fingers flat on
the abdominal wall.
• Press inwards during expiration and allow
passive outward movement during inspiration.

8. a. Light Palpation
• Rigidity and guarding will be felt in children
with peritonitis / perforation,
• Tense abdomen – distention due to gas/ fluid.
• Rebound tenderness – peritonitis
b. Deep Palpation -Liver, Spleen, Kidney

9. Characteristics of Liver
1. Size: Normal liver span-
Infants : 5—6.5 cm;
1—5 years : 6—7 cm;
5—10 years : 7—9 cm;
10—1 5 years : 8—10 cm.
2. Surface
3. Consistency
4. Margins
5. Tenderness

10. Common causes of Hepatomegaly
Infants
Intrauterine infections, like TORCH
group of infections
Septicemia
Neonatal hepatitis
Biliary obstruction
Glycogen storage disorder
Galactosemia
Alpha-i-antitrypsin deficiency
Congestive cardiac failure
Older children
Fatty liver—as in malnutrition
Hepatic abscess: Bacterial or amebic
Lipid storage disorders: Gaucher, Niemann-
Pick disease
Glycogen storage disorders
Hepatitis (acute or chronic)
Tuberculosis
Malignancies Leukemia, lymphoma,
neuroblastoma,and hepatoblastoma
Metabolic diseases Alpha-i-antitrypsin
deficiency, cystic fibrosis, Wilson disease
Congestive cardiac failure, constrictive
pericarditis,
Hemolytic anemia
Veno-occlusive disease,
Extrahepatic obstruction

11. Spleen
Palpation of spleen in right lateral position.
Palpation of spleen
Size:
• Mildly enlarged- palpable 1—2 cm below costal margin.
• Moderately enlarged- palpable 3—7 cm below the costal margin.
• Massive enlargement - palpable >7 cm below the costal margin or crosses
the umbilicus
Consistancy;
Splenic Notch: notch an indentation on the lower medial border of spleen.

12. Common causes of splenomegaly
• Infections: Typhoid, malaria, endocarditis,
septicemia, abscess, toxoplasma,
cytomegalovirus, kala-azar
• Hematologic : Hemolytic anemias, leukemia,
lymphoma, hemangioma
• Infiltrative : Lipid storage disorders (Niemann-
Pick and Gaucher)
• Congestive: Cirrhosis, portal hypertension,
congestive cardiac failure.
• Miscellaneous : SLE

13. Kidney
Palpation of right kidney.
Palpation of left kidney.

14. Renal Lump and Spleen
1. Spleen is not bimanually palpable.
2. Upper border of spleen cannot be reached.
3. Upper border can be felt in a renal lump.
3. Direction of enlargement of spleen is towards
the right iliac fossa.
4. Massive spleen can cross the midline, but a
renal lump will not cross the umbilicus.
5. Splenic notch - confirms the presence of a
spleen.

15. Abdominal lump
• Site and origin: lump is intra-abdominal or
parietal.
(a) Patient lifting his shoulders off the couch (l b) straight leg raising test.

16. Description of an Abdominal Lump
1. Site Which regions are being occupied by the
lump?
2. Origin Intra—abdominal or parietal
3. Size Both in vertical and horizontal planes
4. Shape Round, elongated, or irregular
5. Margins : well or ill-defined.
6. Surface Smooth or nodular
7. Consistency Cystic, firm, or hard
8. Mobility Moving with respiration or otherwise
9. Ballotability
10. Signs of inflammation- present / absent

17. C. Percussion
• Gaseous distension: abdominal distention is due to gas
or fluid.
• In presence of gas in the abdomen, the overlying
percussion note will be resonant or tympanic.
• Masking of liver dullness : Percussion over the liver
normally yields a dull note. In intestinal perforation,
there is accumulation of gas between the diaphragm
and liver. The liver is displaced inferiorly. The usual area
overlying the liver (which should have been dull)
becomes resonant.
• Presence of fluid in the peritoneal cavity will result in
different findings depending upon the amount of fluid
present.

18. • Puddle Sign Shifting Dullness
Demonstration of fluid thrill

19. D. Auscultation
• Bowel sounds: exaggerated in intestinal
obstruction, silent in ileus or peritonitis.
• A renal bruit : in renal artery stenosis,
hypertension or arteritits .
• A venous hum : audible over liver or
spleen in case of vascular tumors

20. E. Genitalia
• Hernial sites, undescended or retractile testis,
ambiguous genitalia, testicular swelling, and
inflammation.
• The urethral opening should be examined for
stenosis, hypospadias, epispadias, chordee (shaft
of penis is curved), phimosis, and penile length.
• Phimosis is inability to retract the prepuce and
may be physiological till 18—24 months of age.
• If the urethra opens on the dorsal surface of the
penis, this is called epispadias and if it opens on
the ventral surface, it is known as hypospadias.
.

21. ABDOMEN
Inspection:
• Shape ---------Prominent Veins ---------Umbilicus – normal / Everted /
other findings---------Peristalsis
Palpation:
• General (Lump / Lumps / Presents / Not Present ( Details to be noted)
• LIVER:Size……Shape…Surface…Consistency---Border…
tenderness…. Pulsatile / non pulsatile…Margins… Liver span (cm)
• Spleen Kidney
• Glands Colon
• Genital Examination
• Rectal Exam
PERCUSSION:
• Free Fluid
• Liver Upper Border…….Lower Border…Bladder -----
AUSCULTATION:
• Bowel sounds

22. Thank You