Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

006 The Abdomen - Introduction to Clinical Surgery Lectures

2,492 views

Published on

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

  • Be the first to comment

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>

×