The abdomen

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The abdomen

  1. 1. Introduction to Clinical Skills The Abdomen Universidad Iberoamericana UNIBE
  2. 2. Introduction to Clinical Skills <ul><li>Midterm Exam </li></ul><ul><ul><li>General appearance </li></ul></ul><ul><ul><li>Vital signs </li></ul></ul><ul><ul><li>Integumentary System </li></ul></ul><ul><ul><li>HEENT and Neck </li></ul></ul><ul><ul><li>Thorax, Lungs and CVC System </li></ul></ul><ul><ul><li>Breast and Axillae </li></ul></ul>
  3. 3. Introduction to Clinical Skills <ul><li>Teaching Staff </li></ul><ul><ul><li>Dra Elizabeth Peralta </li></ul></ul><ul><ul><li>Dr Marcos Núñez </li></ul></ul><ul><ul><li>Dra Cristina Páez C </li></ul></ul><ul><ul><li>Dr Juan Carlos Mariñez </li></ul></ul><ul><ul><li>Dra Wayna Greo </li></ul></ul><ul><ul><li>Dra Yun Pey Lee </li></ul></ul>
  4. 4. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>Anatomy and physiology </li></ul></ul><ul><ul><li>Landmarks </li></ul></ul>
  5. 5. Introduction to Clinical Skills
  6. 6. Introduction to Clinical Skills
  7. 7. Introduction to Clinical Skills
  8. 8. Introduction to Clinical Skills
  9. 9. Introduction to Clinical Skills
  10. 10. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>Anatomy and physiology </li></ul></ul><ul><ul><li>Landmarks </li></ul></ul>
  11. 11. Introduction to Clinical Skills <ul><li>The Abdomen: Health Promotion and Counseling </li></ul><ul><ul><li>Screening for alcohol abuse </li></ul></ul><ul><ul><ul><li>USA: 8.5% population = 17.6 million people </li></ul></ul></ul><ul><ul><ul><li>CAGE questions </li></ul></ul></ul><ul><ul><li>Risk factors for Hepatitis A, B, and C </li></ul></ul><ul><ul><ul><li>Immunizations </li></ul></ul></ul><ul><ul><ul><li>Transfusions </li></ul></ul></ul><ul><ul><li>Screening for Colon Cancer </li></ul></ul><ul><ul><ul><li>PMH: IBD, adenomatous polyps </li></ul></ul></ul><ul><ul><ul><li>Family history </li></ul></ul></ul>
  12. 12. Introduction to Clinical Skills <ul><li>The Abdomen: Health Promotion and Counseling </li></ul><ul><ul><li>CAGE questions </li></ul></ul><ul><ul><li>Have you ever felt the need to Cut Down on drinking ? </li></ul></ul><ul><ul><li>Have you ever fel Annoyed by criticism of your drinking ? </li></ul></ul><ul><ul><li>Have you ever gelt Guilty about drinking ? </li></ul></ul><ul><ul><li>Have you ever taken a drink first thing in the morning ( Eye-opener) to steady your nerves or get rid of a hangover ? </li></ul></ul>
  13. 13. Introduction to Clinical Skills <ul><li>Gastrointestinal Disorders </li></ul><ul><li>Abdominal pain, acute and chronic </li></ul><ul><li>Indigestion, nausea, vomiting, loss of appetite, early satiety </li></ul><ul><li>Dysphagia and/or odinophagia </li></ul><ul><li>Change in bowel function </li></ul><ul><li>Diahrrea, constipation </li></ul><ul><li>Jaundice </li></ul><ul><li>Urinary Disorders </li></ul><ul><li>Suprapubic pain </li></ul><ul><li>Dysuria, urgency, or frequency </li></ul><ul><li>Hesitancy, decreased stream in males </li></ul><ul><li>Polyurea or nocturia </li></ul><ul><li>Urinary incontinence </li></ul><ul><li>Hematuria </li></ul><ul><li>Kidney or flank pain </li></ul><ul><li>Ureteral colic </li></ul>
  14. 14. Introduction to Clinical Skills <ul><li>The Abdomen: Pattern and Mechanisms of Abdominal Pain </li></ul><ul><ul><li>Visceral pain </li></ul></ul><ul><ul><ul><li>Hollow viscus distention </li></ul></ul></ul><ul><ul><ul><li>Solid organs capsule stretch </li></ul></ul></ul><ul><ul><ul><li>Difficult to localize </li></ul></ul></ul><ul><ul><li>Parietal pain </li></ul></ul><ul><ul><ul><li>Inflammation parietal peritoneum </li></ul></ul></ul><ul><ul><ul><li>More sever, localized </li></ul></ul></ul><ul><ul><li>Referred pain </li></ul></ul><ul><ul><ul><li>Distant sites </li></ul></ul></ul><ul><ul><ul><li>Same spinal nerves as the disordered structures </li></ul></ul></ul>
  15. 15. Introduction to Clinical Skills
  16. 16. Introduction to Clinical Skills
  17. 17. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>Inspection </li></ul></ul><ul><ul><li>Auscultation </li></ul></ul><ul><ul><li>Percussion </li></ul></ul><ul><ul><li>Palpation </li></ul></ul>
  18. 18. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>Inspection. Tips for the Examination </li></ul></ul><ul><ul><ul><li>Empty bladder </li></ul></ul></ul><ul><ul><ul><li>Supine position, comfortable </li></ul></ul></ul><ul><ul><ul><li>Flex hips and knees </li></ul></ul></ul><ul><ul><ul><li>Warm hands and stethoscope </li></ul></ul></ul><ul><ul><ul><li>Identify painful areas </li></ul></ul></ul><ul><ul><ul><li>Distraction as necesary </li></ul></ul></ul>
  19. 19. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>Inspection </li></ul></ul><ul><ul><ul><li>Skin: Scars, striae, dilated veins, rashes and lesions </li></ul></ul></ul><ul><ul><ul><li>Umbilicus: Contour and location </li></ul></ul></ul><ul><ul><ul><li>Shape-contour; Symmetric, flat scaphoid, prominent </li></ul></ul></ul><ul><ul><ul><li>Peristalsis (visible) </li></ul></ul></ul><ul><ul><ul><li>Pulsations (Aorta) </li></ul></ul></ul>
  20. 20. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>Auscultation: 4 quadrants </li></ul></ul><ul><ul><ul><li>Peristalsis </li></ul></ul></ul><ul><ul><ul><li>Bruits </li></ul></ul></ul>
  21. 21. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>Percussion </li></ul></ul><ul><ul><ul><li>Timpany </li></ul></ul></ul><ul><ul><ul><li>Dullnes </li></ul></ul></ul>
  22. 22. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>Palpation: muscle tone, pain </li></ul></ul><ul><ul><ul><li>Light palpation </li></ul></ul></ul><ul><ul><ul><li>Deep palpation </li></ul></ul></ul><ul><ul><ul><li>Assessment for peritoneal inflammation </li></ul></ul></ul>
  23. 23. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>The Liver </li></ul></ul><ul><ul><ul><li>Percussion </li></ul></ul></ul><ul><ul><ul><ul><li>Liver span </li></ul></ul></ul></ul><ul><ul><ul><li>Palpation: right side </li></ul></ul></ul>
  24. 24. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>The Liver </li></ul></ul><ul><ul><ul><li>Percussion </li></ul></ul></ul><ul><ul><ul><ul><li>Liver span </li></ul></ul></ul></ul><ul><ul><ul><li>Palpation : right side </li></ul></ul></ul>
  25. 25. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>The Spleen </li></ul></ul><ul><ul><ul><li>Percussion </li></ul></ul></ul><ul><ul><ul><li>Palpation: left side </li></ul></ul></ul>
  26. 26. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>The Kidneys </li></ul></ul><ul><ul><ul><li>Costovertebral tenderness test </li></ul></ul></ul><ul><ul><ul><li>Clench fist test </li></ul></ul></ul><ul><ul><ul><li>Bimanual palpation </li></ul></ul></ul>
  27. 27. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>Assessment Techniques for: </li></ul></ul><ul><ul><ul><li>Ascites </li></ul></ul></ul><ul><ul><ul><li>Appendicitis </li></ul></ul></ul><ul><ul><ul><li>Acute cholecystitis </li></ul></ul></ul><ul><ul><ul><li>Ventral hernia </li></ul></ul></ul><ul><ul><ul><li>Mass in abdominal wall </li></ul></ul></ul><ul><ul><ul><li>Pregnancy </li></ul></ul></ul>
  28. 28. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>Pelvic Organs </li></ul></ul><ul><ul><ul><li>Bladder </li></ul></ul></ul><ul><ul><ul><li>Internal Genitalia </li></ul></ul></ul><ul><ul><li>Retroperitoneal Organs </li></ul></ul><ul><ul><ul><li>Kidneys </li></ul></ul></ul><ul><ul><ul><li>Adrenals </li></ul></ul></ul><ul><ul><ul><li>Aorta / IVC </li></ul></ul></ul><ul><ul><li>Thoracolumbar Spine </li></ul></ul><ul><ul><ul><li>Xifosis </li></ul></ul></ul><ul><ul><ul><li>Lordosis </li></ul></ul></ul>
  29. 29. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>Pelvic Organs </li></ul></ul><ul><ul><ul><li>Bladder </li></ul></ul></ul><ul><ul><ul><li>Internal Genitalia </li></ul></ul></ul><ul><ul><li>Retroperitoneal Organs </li></ul></ul><ul><ul><ul><li>Kidneys </li></ul></ul></ul><ul><ul><ul><li>Adrenals </li></ul></ul></ul><ul><ul><ul><li>Aorta / IVC </li></ul></ul></ul><ul><ul><li>Thoracolumbar Spine </li></ul></ul><ul><ul><ul><li>Xifosis </li></ul></ul></ul><ul><ul><ul><li>Lordosis </li></ul></ul></ul>
  30. 30. Introduction to Clinical Skills <ul><li>The Abdomen: anterior-posterior </li></ul><ul><ul><li>Pelvic Organs </li></ul></ul><ul><ul><ul><li>Bladder </li></ul></ul></ul><ul><ul><ul><li>Internal Genitalia </li></ul></ul></ul><ul><ul><li>Retroperitoneal Organs </li></ul></ul><ul><ul><ul><li>Kidneys </li></ul></ul></ul><ul><ul><ul><li>Adrenals </li></ul></ul></ul><ul><ul><ul><li>Aorta / IVC </li></ul></ul></ul><ul><ul><li>Thoracolumbar Spine </li></ul></ul><ul><ul><ul><li>Xifosis </li></ul></ul></ul><ul><ul><ul><li>Lordosis </li></ul></ul></ul>
  31. 31. Introduction to Clinical Skills <ul><li>Recording your findings </li></ul><ul><ul><li>“ Abdomen is protuberant with active bowel sounds.It is soft and nontender, no palpable masses or heaptosplenomegaly. Liver span is 7cm in the right LCL, edge is smooth and palpable 1 cm below the right costal margin. Spleen and kidneys not felt. No costovertebral angle (CVA) tenderness” </li></ul></ul>
  32. 32. Introduction to Clinical Skills

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