The document provides guidance on examining patients for gastrointestinal problems. It outlines key questions to ask patients about common GI symptoms like abdominal pain, dysphagia, vomiting, heartburn, indigestion, changes in bowel habits, loss of appetite and weight loss. It also describes the physical examination of the abdomen, including inspecting the peripheral body and specifically examining the abdomen to look for signs of GI disease. The examination is aimed at gathering relevant clinical history and identifying abnormalities that may indicate underlying conditions.
SYMPTOMS & SIGNS IN GIT PROBLEMS
• Dear Viewers
• Greetings from “ Surgical Educator”
• I am uploading a PPT presentation on symptoms and signs in GI problems
• What are the questions you have to ask the patients for each problem in GIT is explained
• How to examine and elicit various signs in abdomen is also explained
• I hope this PPT presentation will be very useful to you
• You can watch all my surgery teaching videocasts in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
SYMPTOMS & SIGNS IN GIT PROBLEMS
• Dear Viewers
• Greetings from “ Surgical Educator”
• I am uploading a PPT presentation on symptoms and signs in GI problems
• What are the questions you have to ask the patients for each problem in GIT is explained
• How to examine and elicit various signs in abdomen is also explained
• I hope this PPT presentation will be very useful to you
• You can watch all my surgery teaching videocasts in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
PANEL MODUL ACUTE ABDOMINAL PAIN (NYERI AKUT ABDOMEN)Rindang Abas
A 17 years old female came to clinic with complaints of pain in the main section of the gastric experienced since 3 days eralier, accompanied by nausea and vomiting, especially after eating or drinking. In anamnesis, aware that she regularly taking medication to relieve pain anticolic due to menstruation.
Jagiellonian University Medical College's SSIG presentation on the basics of the acute abdomen (12.04.2018)
All content has been credited to their respectful owners.
Get the best homeopathy medicines for painful bleeding, non-bleeding, external and internal piles,Fissure & Fistula which can avoid surgery and gives a permanent cure to piles.Visit Multicare Homeopathy
Visit:https://www.multicarehomeopathy.com/diseases/6-best-homeopathic-medicines-for-piles-which-can-avoid-surgery
PANEL MODUL ACUTE ABDOMINAL PAIN (NYERI AKUT ABDOMEN)Rindang Abas
A 17 years old female came to clinic with complaints of pain in the main section of the gastric experienced since 3 days eralier, accompanied by nausea and vomiting, especially after eating or drinking. In anamnesis, aware that she regularly taking medication to relieve pain anticolic due to menstruation.
Jagiellonian University Medical College's SSIG presentation on the basics of the acute abdomen (12.04.2018)
All content has been credited to their respectful owners.
Get the best homeopathy medicines for painful bleeding, non-bleeding, external and internal piles,Fissure & Fistula which can avoid surgery and gives a permanent cure to piles.Visit Multicare Homeopathy
Visit:https://www.multicarehomeopathy.com/diseases/6-best-homeopathic-medicines-for-piles-which-can-avoid-surgery
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
1. SYMPTOMS & SIGNS
IN GI PROBLEMS
کی ہضم امراض
نشانیاں و عالمات
Dr Syed Ayesha Fatema
MD Medicine
Professor
PG dept of Moalijat
ZVMUMCH Pune
3. SYMPTOMS IN GI PROBLEMS
• Pain abdomen
• Difficulty in swallowing- Dysphagia
• Vomiting
• Heartburn- Retrosternal pain- Pyrosis
• Indigestion
• Change in bowel habits- Constipation /
Diarrhea
• Loss of appetite/ Loss of weight
4. BASIC QUESTIONS YOU WOULD ASK IN ABDOMINAL
PAIN
When did the pain start?
Where is it, show me?
Have you ever had it before?
Did it come on suddenly or
gradually?
Does it go anywhere else?
Show
How bad is it, worst you have
ever had, severe, very severe,
mild, moderate, just an ache
(do not use x/10 unless you
define 10)?
Is it the same all the time?
Have you had time completely
free of pain since it started?
Is it constant or comes in
waves?
Is it getting worse?
What makes it better, e.g. lying
still / painkillers?
What makes it worse, e.g.
moving about?
Have you got any other
symptoms with it, give
examples, e.g. vomiting/fever
5. BASIC QUESTIONS YOU WOULD ASK IN
DYSPHAGIA
How long have you had
the problem?
Describe what it is like?
Have you had it before?
Did it come on gradually or
suddenly?
Is it becoming worse?
Do you have difficulty with
solids and/or liquids?
Which came first?
Does the food seem to
stick. Show me where?
Have you been vomiting,
what, etc
How is your appetite?
Have you lost weight?
Plus, all the other GI
protocol questions
Plus, do you feel anything
else wrong with you at
present.
6. BASIC QUESTIONS YOU WOULD ASK IN
VOMITING
When did the vomiting
start?
What do you vomit?
Is it food/ water/ bile/ greeny
stuff /acid/blood?
If food, is it food you have
just eaten or old food?
If it is blood, how do you
know?
Amount, color, clots, coffee
grounds.
How often do you vomit?
Do you feel sick nauseated)
all the time?
Does anything bring the
vomiting on(worse)?
Does anything make it
better?
Does it shoot out with great
force (projectile)?
Any coughing or choking?
7. BASIC QUESTIONS YOU WOULD ASK IN
RETROSTERNAL PAIN
Describe it to me .
How long have you had it?
Have you had it before this
episode?
Did it come on gradually or
suddenly?
Is it becoming worse?
What makes it worse (e.g. lying
down in bed, bending over,
certain types of food and drink-
spicy food/ alcohol/ coffee)?
What makes it better ( sleeping,
sitting up, avoiding certain
drinks or food, medications)?
Do you get any acid reflux-acid
or water coming into your
mouth, describe this please
(distinguish acid reflux and
water-brash).
Do you have any difficulty
swallowing? Describe.
Do you have any pain behind
the chest bone? Describe.
Do you vomit?
Do you have indigestion?
Have you put on weight
recently?
8. BASIC QUESTIONS YOU WOULD ASK IN
INDIGESTION
Do you have any indigestion, if
says 'yes'?
Ask what do you mean by this, if
says 'no; ask: do you have any
discomfort or pain in your tummy
after eating?
Where is the discomfort, show
me (pointing sign of DU)?
When do you get it-before
meals/ after meals?
Does it wake you at night (DU),
what do you do about it, e.g. get
up have some milk and a
biscuit?
How often do you get it, e.g.
every day?
Have you had it before?
Have you seen your GP about it
or been investigated in hospital
(e.g. endoscopy)?
What did they say was wrong
with you?
What makes the indigestion
worse/better?
Have you been vomiting any
blood?
How is your appetite; have you
lost weight?
Do you take any medications for
it (define)?
Are you taking aspirin / NSAIDs
/ steroids/ herbal medications?
9. BASIC QUESTIONS YOU WOULD ASK IN
ALTERED BOWEL HABITS
Has your bowel habit
changed recently?
If patient does not appear to
understand-Explain.
Have you developed
diarrhea or constipation
recently (means different
things to different people)?
Define their normal bowel
habit.
Define what it has changed
to, e.g. normal is x 1 per day
now is x 3 per day.
If has diarrhea-define
content, color, offensive,
blood/floats
If has constipation-is it
constipation or incomplete
evacuation? or even
tenesmus
Have you passed any blood
or slime? Define both.
Have you had any abdominal
pain or weight loss?
On any drugs ( e.g.
antibiotic)?
10. BASIC QUESTIONS YOU WOULD ASK IN DIARRHEA
Frequency of defecation
(>x3 = abnormal).
Recent or present for long
time.
Solid/liquid/mixed./?
Bulky may be steatorrhea.
Color:
Black (melena),
red (blood),
pale (steatorrhea,
obstructive jaundice),
silver (because of mixture
of melena and fatty stool in
tropical sprue, carcinoma
(Ca) of ampulla of Vater).
Pus or mucus.
Smell-very offensive, may be
infective/melena.
Floats/ difficult to flush away,
may be steatorrhea.
Any other symptoms, e.g.
vomiting.
Been abroad recently.
Anyone else in family with it
(gastroenteritis).
NB: Some gastroenterologists
divide by physiological cause
into secretory, osmotic,
exudative, malabsorption (not
very useful in practice).
11. BASIC QUESTIONS YOU WOULD ASK IN
CONSTIPATION
What do you mean by
constipation infrequent bowel
action or very hard motion or
difficulty in evacuation?
Is this a new symptom or long
standing?
If recent, define 'change': Normal
bowel habit versus old bowel
habit.
Any blood or mucus?
Incomplete emptying-have to go
again-is a symptom of pelvic
floor descent or rectal cancer-
Tenesmus
Any incontinence- overflow or
otherwise?
Painful almost continuous urge
to defecate is tenesmus (rectal
equivalent of urinary strangury)
indicates inflammation or tumor
involving anal sphincters.
Other GI symptoms, e.g.
abdominal pain/distension.
On any drugs, e.g. codeine.
Alternating diarrhea +
constipation,
some say symptom of tumor but
more likely irritable bowel
syndrome (large bowel tumor is
more often change from normal
to more frequent).
12. BASIC QUESTIONS YOU WOULD ASK IN LOSS
OF APPETITE/ LOSS OF WEIGHT
Loss of appetite
When did this happen,
did it start same time as
other GI symptoms?
Loss of appetite
(anorexia) + weight loss =
Suspicious of
malignancy.
Increase in appetite, may
suggest hypermetabolic
state, e.g. thyrotoxicosis
Loss of Weight
When did it start?
How much (in kg over
weeks) if patient not sure,
ask about loose clothes?
Why do you think lost
weight-may say on diet? -
intentional or unintentional
Are there other symptoms
may need full review of
systems, e.g. fever/thirst?
14. ABDOMINAL EXAMINATION
INTRODUCTION (WIPER)
W - Wash your hands.
I - Introduce yourself to the patient
P -Permission. Explain that you wish to perform an
abdominal examination and obtain consent for the
examination. Pain. Ask the patient if they are in any pain and
to tell you if they experience any during the examination.
E -Expose the necessary parts of the patient. Ideally
patients should be exposed from xiphisternum to pubis
(classically they should be exposed from “nipples to knees”,
but this is rarely done in practice to preserve patient dignity).
Ensure adequate privacy.
R -Reposition the patient. In this examination the patient
should be lying flat with one pillow under the head. This is
not possible with all patients so first check if they are
comfortable in this position.
15. During the examination of the abdominal system a
lot of information can be obtained by looking for
peripheral signs of gastro-intestinal disease.
The examination is therefore split into a peripheral
examination and then an examination of the
abdomen.
16. PERIPHERAL EXAMINATION
End of the Bed
• First look at the patient from the end of the bed for
signs of anxiety or distress.
• Note any weight loss and assess level of hydration and
general well being. Are there signs of easy bruising?
• Are there any drains, stoma bags or signs of an AV
(arteriovenous) fistula?
• It is also important to look at the surrounding
environment for sick bowels, food supplements, special
dietary notices and ‘nil by mouth’ instructions etc.
17. FACE:
Jaundice
Lemon yellow (uremia, CA
cecum, pernicious anemia)
Weight loss (temporalis muscles,
cheeks )-
Cachexia
Dehydration
Distress (pain)
Pale (anemia/pain)
Flushed (temperature)
Parotid swelling (alcohol abuse,
iron deficiency anaemia) and
Bruising.
EYES:
Yellow sclera (Jaundice)
Pale mucous membranes of
conjuctiva (anaemia)
Xanthelasma (chronic
cholestasis)
Kayser-Fleischer rings (Wilson's
disease, primary biliary
cholangitis and children with
neonatal cholestasis)
MOUTH:
Angular stomatitis (B12
deficiency, Fe deficiency)
Pigmentation (Peutz-Jeghers
syndrome)
Aphthous Ulcers (Crohn's
disease)
18. TONGUE
Glossitis.
Red and beefy = folate /B12 deficiency
atrophic and smooth = iron deficiency
HANDS:
Finger nails leukonychia (low protein)
Koilonychia (Fe deficiency)
Clubbing (UC/Cirrhosis)
Palmar erythema, and
Dupuytren’s contracture
PALMS:
Pale creases (anemia)
Palmar erythema (liver failure)
Liver flap (liver failure)
ARMS:
Scratch marks ( obstructive jaundice)
19. NECK:
Enlarged lymph nodes (supraclavicular -
CA stomach)
LEGS:
Superficial thrombophlebitis
(Pancreatic CA)
AXILLA:
Acanthosis Nigricans (Ca stomach)
Irish nodes ( Ca stomach)
CHEST:
Spider nevi (>5 is abnormal) (liver failure)
Gynecomastia (liver failure)
Distribution of body hair, particularly paucity of hair (liver
disease).
20. EXAMINATION OF THE ABDOMEN
Inspection
First inspect abdomen from the end of the bed
before closer inspection at bedside.
Initially look for general signs such as weight loss.
Then check specifically for other signs.
21. ABDOMEN:
Inspection:
Shape or symmetry
No movement with respiration
(peritonitis)
Jaundiced skin
Distended (obstruction,
ascites, 5Fs – flatus, faeces,
foetus, fat, fluid)
Weight loss (malignancy)
Scars (previous surgery) and
striae
Fistula (Crohn's)
Everted umbilicus (ascites)
Mass ( tumor, abscess)
Visible peristalsis (intestinal
obstruction or chronic pyloric
stenosis )
Pulsatile Swelling-
Expansile/transmitted (hernia)
Enlarged veins + caput
medusa (liver disease)
Cullen's/Grey Turner's
sign(pancreatitis)
Erythema (pain /hotwater
bottle use)
Cellulitis ( abscess-diverticular
disease/ tumor)
22. Palpation
Position yourself by kneeling or sitting on the patient’s
right hand side. Ensure your hands are warm. Ask patient
if they have any pain or tenderness.
Begin with light palpation of the ninth segment. If patient
has complained of pain begin at opposite side.
Observe patient’s face throughout palpation to ensure
that you are not causing pain.
Light palpation is used to assess tenderness and
guarding (a sign of irritation of the peritoneum).
Proceed next to deep palpation of the same nine
segments. Deep palpation is used to assess for masses.
If appropriate, test for rebound tenderness (a sign of
intra-abdominal pathology)
24. METHOD OF PALPATION OF ORGANS
Liver
A normal liver extends from 5th intercostals space to costal
margin.
It may be palpable in normal individuals.
Position your hand in the right iliac fossa with fingers in an
upward position facing the liver edge (alternatively you can
use the radial aspect of your index finger).
Press your fingertips inward and upward and hold this
position while your patient takes a deep breath.
As the liver moves downward with inspiration the liver edge
will be felt under fingertips.
If no edge is felt repeat the procedure closer and closer to
the costal margin until either the liver is felt or the rib is
reached.
25. Spleen
The normal spleen cannot be felt and only becomes
palpable when it has doubled in size.
It enlarges from under the left costal margin towards the
right iliac fossa.
The fingertips of right hand are then positioned obliquely
across the abdomen pointing to the left costal margin
towards the axilla (again, you may use the radial aspect of
your index finger).
Press your fingertips inward and upward and hold this
position while your patient takes a deep breath.
26. As the spleen moves with inspiration the edge may be
felt under your fingertips.
If no edge is felt repeat the procedure closer and closer
to the left lower rib cage until the costal margin is
reached.
If the spleen is not palpable, this procedure can then be
repeated with the patient rolled onto right lateral position
with knees drawn up to relax abdominal position.
Palpate with your right hand while using your left hand to
press forward on the patient’s left lower ribs from behind.
It could be argued that this method should be used first,
since very few patients have spleens which have
enlarged to occupy the right iliac fossa.
27. Kidneys
The kidneys are retroperitoneal, so not usually palpable
except in some thin individuals.
To examine left kidney, place the palmar aspect of left hand
posteriorly under left flank.
Position the middle three fingers of right hand below the left
costal margin, lateral to the rectus muscle (opposite
position of left hand).
Ask patient to take deep breath and press both fingers
firmly together.
If the kidney is palpable it will be felt slipping between both
fingers.
To examine the right kidney repeat the procedure with your
left hand tucked behind the right loin and your right hand
below the costal margin, lateral to the rectus muscle.
28. Aorta
In thin patients or those with a dilated aorta, the aorta
can be palpated by placing both hands
on either side of the midline at a point half way
between the xiphisternum and the umbilicus.
Press your fingers posteriorly and slightly medially and
the pulsation should be present against your
fingertips.
29. Liver
Begin by establishing lower liver edge.
Place hands parallel to the right costal margin starting at
the same point as you began palpation.
Repeat in a stepwise manner moving the fingers closer to
the costal margin until the note becomes duller.
This is the position of the lower liver edge.
Next find the upper margin of the liver.
It can be located by detecting a change in note from the
dullness of liver to resonance of lungs.
METHOD OF PERCUSSION
OF ORGANS
30. Spleen
Begin by percussing the ninth intercostal space
anterior to the anterior axillary line (Traub’s space).
If the spleen is not enlarged the sound will be
tympanic.
If it is dull continue to percuss in a stepwise manner
moving hands towards right iliac fossa.
31. Ascites patient
If fluid is suspected percuss across patients abdomen
(from midline to right flank) until the percussion note
changes from tympanic to dull.
Mark that spot and then ask your patient to turn onto their
right side (if you are standing on left of patient).
After 30seconds repeat percussing from the midline
towards the right flank.
If fluid is present it will have redistributed secondary to
gravity and therefore the area previously marked as
sounding dull to percussion will now be tympanic.
Bladder
If the bladder is distended the suprapubic area will be dull
rather than tympanic.
Percuss from the level of the umbilicus, parallel to the
pubic bone.
32. AUSCULTATION TECHNIQUE
Bowel sounds
Place the diaphragm of your stethoscope on the mid
abdomen and listen for gurgling sounds.
These normally occur every 5-10seconds however you
listen for 30 seconds before concluding that they are
absent.
Absent bowel sounds indicates intestinal ileus.
Increased bowel sounds indicate bowel obstruction.
33. Arterial bruits
Place diaphragm of stethoscope over aorta and apply
moderate pressure.
If a systolic murmur is heard this indicates turbulent flow
caused by atherosclerosis or an aneurysm.
Listen for renal bruits 2.5cm above and lateral to the
umbilicus.
Then listen over liver and spleen.
34. FINISHING OFF
State that you would complete the examination by:
• Checking for any lympahdenopathy
• Examining the hernial orifices
• Examining the external genitalia
• Performing a digital examination of the anus and
rectum
• Performing a urinary ‘dipstick’ analysis if needed
Editor's Notes
DuodenalUlcer
Peutz–Jeghers syndrome (often abbreviated PJS) is an autosomal dominant genetic disorder characterized by the development of benign hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules on the lips and oral mucosa (melanosis).
Dupuytren's contracture is a condition in which one or more fingers become permanently bent in a flexed position. It usually begins as small, hard nodules just under the skin of the palm, then worsens over time until the fingers can no longer be straightened.