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Abdomen exam

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an overview of examination of abdomen/tummy for medical students

Published in: Health & Medicine

Abdomen exam

  1. 1. Abdomen History & Examination
  2. 2. Important history  Dyspepsia- heartburn  Dysphagia- difficulty swallowing  Altered bowel habit- diarrhea/constipation  Pain- colicky, stretch, radiation, referred  Bleeding- UGI/LGI  Jaundice  Urinary symptoms- hematuria, dysuria, frequency, urgency, hesitancy, retention  Appetite  Dietary history
  3. 3. Examination  Oral cavity  Abdomen  Male genitalia  Anus/rectum
  4. 4. Oral cavity  Angular stomatitis, cheilitis  Teeth- number, color, ridges, caries  Gums- swelling, bleeding, pyorrhea  Buccal mucosa- ulcer, pigmentation  Tongue- size, color, papillae  Palate, tonsils, pharynx
  5. 5. Abdomen- regions  4- vertical & horizontal planes thru umbilicus- RUQ, RLQ, LUQ, LLQ  9- vertical planes thru 9th costal cartilage & femoral artery; horizontal planes are subcostal & interiliac- R & L hypochondrium, lumbar, iliac and epigastrium, umbilical, hypogastrium
  6. 6. Abdomen- regions
  7. 7. Quadrants & organs  RUQ- liver, GB, upper pole of R kidney, hepatic flexure of colon  LUQ- stomach, spleen, pancreas, upper pole of L kidney, splenic flexure of colon  RLQ- lower pole of R kidney, appendix, terminal ileum, R colon, R ovary  LLQ- lower pole L kidney, L colon, L ovary
  8. 8. Pre-examination  Comfortable room & couch  Adequate light  Patient lying supine  Adequate exposure  Examiner’s hand at the level of patient’s abdomen
  9. 9. Examination- components  Inspection- see, don’t touch  Palpation- touch  Percussion- tap  Auscultation- use stethoscope
  10. 10. Inspection  Shape- scaphoid, normal, distended  Umbilicus- shape, inverted/everted  Movements- normal or restricted, pulsation, visible peristalsis  Striae or scars  Prominent veins  Genitalia & groin
  11. 11. Palpation  Relaxed patient & abdominal wall  Start from the point farthest from possible area of involvement e.g. for liver start from LLQ & for spleen from RLQ  Palpate whole abdomen in an order
  12. 12. Special techniques  Deep palpation- in obese, muscular or poorly relaxed  Dipping- tense ascites  Bimanual- for kidney & spleen  Ballotable- kidney  Shifting dullness & fluid thrill- for ascitis
  13. 13. It helps  Spleen  L hypochondrium  Grows towards RLQ  Upper border not reached  Moves with respiration  Medial notch  Not ballotable  Dull on percussion  L kidney  Renal angle posteriorly  Grows towards LLQ  Upper border reachable  Restricted mobility  No notch  Ballotable  Colon overlying on percussion
  14. 14. Liver  RUQ  Moves with respiration  Tender or not?  Edge- soft, firm, hard  Surface- smooth, nodular  Pulsatile in TR  Confirm span by percussion
  15. 15. Gall bladder  Underlies liver in RUQ  Moves with respiration  Usually not palpable  Tender- Murphy’s sign- +ve in acute cholecystitis  Palpable GB- mucocoele, cancer, CBD obstruction
  16. 16. Urinary bladder  Midline, suprapubic  Usually not palpable  When palpable- smooth, symmetrical, lower border not reached,  Urge to micturate on palpation  Dull on percussion
  17. 17. Percussion  Only light percussion required  Resonant note allover, except over liver where it is dull  Used to confirm liver or spleen or bladder enlargement & ascitis
  18. 18. Auscultation  Paraumbilical  For bowel sounds or bruit  Normal BS- intermittent gurgles interspersed with tinkles  Increased- intestinal obstruction  Decreased- paralytic ileus  Bruit- over aorta, iliac/renal arteries
  19. 19. Don’t forget  Groin- LNE, hernia  Male genitalia  PR examination- for local pathology, prostate examination in males
  20. 20. Stigmata of CLD  Muscle wasting  Pallor, jaundice  Clubbing  Palmar erythema  Dupuytren’s contracture  Spider nevi  Gynecomastia  Testicular atrophy  Caput medusae  Ascites
  21. 21. Supported by X-ray, US/CT, Endoscopy

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