summary of abdominal examination

1. ABDOMINAL
EXAMINATION
PRESENTED BY:-
DR SHASHANK AGRAWAL
MODERATOR :-
DR A.B.MOWAR SIR

2. COMMON COMPLAINTS
Anorexia Nausea
vomiting Dysphagia
flatulance Retrosternal Burning
Diarrhoea Constipation
Clay colour stool Worms/mucous in stool
Black tarry stool
Abdominal pain/ lump Abdominal distension
Hematemesis Melena
Epistaxis Bleeding per rectum

3. PAST HISTORY
Tuberculosis malaria
Kala azar Leukemia
Hemolytic crisis Sexual contact
Bleeding disorder H/O Blood transfusion
Surgery Jaundice

4. GENERAL INSPECTION
• Nutritional state (wasting) BMI
• Pallor
• Jaundice (liver disease)
• Pigmentation (hemochromatosis)
• Mental state (encephalopathy)

5. hands
• Nails
– Clubbing
– Koilonychia
– Leuconychia
• Palmar erythema
• Dupuytren’s contractures
• Hepatic flap

6. HANDS
Palmar erythema Dupuytren’s contractures

7. ARMS
• Spider naevi (telangiectatic lesions)
• Bruising
• Scratch marks (chronic cholestasis)

8. FACE, EYES …
• Conjuctival pallor
• Sclera: jaundice
• Cornea: Kaiser Fleischer’s rings (Wilson’s disease)
• Xanthelasma (primary biliary cirrhosis)
• Parotid enlargement (alcohol)

9. Parotid enlargement
Xanthelasma

10. … AND MOUTH
• Fetor Hepaticus
• Lips
– Angular stomatitis
– Cheilitis
– Ulceration
• Gums
– Gingivitis, bleeding
– Candida albicans
– Pigmentation

11. Atrophic glossitis Thrush

12. NECK AND CHEST
• Cervical lymphadenopathy
• Left supraclavicular fossa (Virchow’s node)
• Gynaecomastia
• Loss of hair

13. POSITIONING
• Abdomen can be divided in four quadrants
• Patient should be lying on supine position

14. REGIONAL DIVISION OF ABDOMEN

15.  Liver: left lobe
 Spleen
 Stomach
 Jejunum and proximal ileum
 Pancreas: body and tail
 Left Kidney
 Left Suprarenal gland
 Left colic (splenic) flexure
 Transverse colon: left half
 Descending colon: superior
part
15
LEFT UPPER QUADRANT

16. RIGHT UPPER QUADRANT
 Liver: right lobe
 Gallbladder – Murphy’s sign
 Stomach: pylorus
 Duodenum: parts 1-3
 Pancreas: head
 Right suprarenal gland
 Right kidney
 Right colic (hepatic) flexure
 Ascending colon: superior
part
 Transverse colon: right half
16

17. RIGHT LOWER QUADRANT
Cecum
Vermiform appendix
Most of ileum
Ascending colon: inferior
part
Right ovary
Right uterine tube
Right spermatic cord
Uterus (if enlarged)
Urinary bladder (if full)
17

18. LEFT LOWER QUADRANT
Sigmoid colon
Descending colon:
inferior part
Left ovary
Left uterine tube
Left ureter: abdominal
part
Left spermatic cord:
abdominal part
Uterus (if enlarged)
Urinary bladder (if full)
18

19. BEFORE EXAMINATION
Ensure that bladder is empty
Patient comfort
Arms at side or crossed over chest
Ask the patient to point to any painful areas;
examine last
Warm hands and stethoscope
19

20. INSPECTION
• Shape and movements
• Scars
• Distension
• Prominent veins
• Striae
• Bruises
• Pigmentation
• Visible peristalsis - pyloric stenosis- left to right
large intestine obstruction- left to right

21. normal pregnancy ascites fatty abdomen
SHAPE

22. SCARS

23. ABDOMINAL MOVEMENT
• Normal:
– Male : Abdomino-thoracic
– Female : Thoraco-abdominal
– Infant : Thoraco- abdominal
• Disease :
– Diaphragmatic palsy: bulging during
expiration
– Peritonitis : no movement

24. ABDOMINAL PULSATION
• Aortic pulsation- visible in nervous, anemia
• Aortic aneurysm- expansile pulsation in any position
• Transmitted pulsation- any mass lying over major
artery produce pulsation. On making puddle sign it
will disappear.
• Rt ventricular pulsation seen in epigastric region
• Congestive liver produce pulsation posteriorly

25. DILATED VEIN

26. HERNIAL SITES

27. PALPATION
1. Ensure that your hands are warm
2. Stand on the patient’s right side
3. Help to position the patient
4. Ask whether the patient feels any pain before
you start
5. Begin with superficial examination
6. Move in a systematic manner through the
abdominal quadrants
7. Repeat palpation deeply.

28. PALPATION
• Characteristics of an abdominal mass
1. location
2. size
3. shape
4. consistency
5. surface
6. tenderness
7. movable or fixed
8. shifting by respiration

29. LIGHT PALPATION

30. DEEP PALPATION

31. PALPATION
• Tenderness: discomfort and resistance to palpation
• Involuntary guarding: reflex contraction of the
abdominal muscles
• Rebound tenderness: patient feels pain when the
hand is released
• Tenderness + rigidity: perforated viscus
• Palpable mass (enlarged organ, faeces, tumour)
• Aortic pulsation

32. • Pain in RUQ
• Inflammation of gallbladder
(cholecystitis)
MURPHY’S SIGN

33. • 1/3 ASIS to umbilicus
• Location of AV in retrocecal position
• Deep tenderness (= acute appendicitis)
MCBURNEY’S POINT

34. rebound tenderness
• Pain upon removal of pressure rather than application of
pressure to the abdomen
• Peritonitis and/ or appendicitis
BLUMBERG’S SIGN

35. FLUID THRILL
 Place the palm of your left hand
against the left side of the
abdomen
 Flick a finger against the right side
of the abdomen
 Ask the patient to put the edge of
a hand on the midline of the
abdomen
 If a ripple is felt upon flicking we
call it a fluid thrill = ascites

36. Puddle sign

37. PALPATION OF THE LIVER
1. Flex the knee joint
2. Ask the patient to take a deep breath in
3. Start palpating in the right iliac fossa
4. Move hand progressively further up the abdomen
5. Try to feel the liver edge
6. Check for tha liver span.

39. PALPATION OF THE SPLEEN
1. Roll the patient towards you
2. Start from right illiac fossa
3. Palpate with right hand while using left hand to press forward on
the patient’s lower ribs from behind
4. Feel along the costal margin

40. SPLEENOMEGALY
• Traube's Space boundaries -Left anterior
axillary line, 6th rib, costal margin
• Castell’s - resonating traube’s area
Nixon’s method - dullness extends >8 cm

42. BIMANUAL PALPATION

43. PERCUSSION
• Dull sounds: solid or fluid-filled structures
• Resonant sounds: structures containing air or gas
• Shifting dullness

44. SHIFTING DULLNESS

45. AUSCULTATION
• Place the diaphragm of the stethoscope to
the right of the umbilicus
• Bowel sounds (borborygmi) are caused by
peristaltic movements
• Occur every 5-10 sec.
• Absence of b.s.: paralytic ileus or peritonitis
• Bruits over aorta and renal a. could be a
sign of an aneurysm and stenosis

46. OTHER EXAMINATION
EXAMINATION OF HERNIA
PER RECTAL EXAMINATION
INSPECTION
PALPATION

47. FEW DIFFERENCE
• ASCITES MYSENTRIC CYST
• SPLEEN LUMP KIDNEY LUMP
• ASCITES OVARIAN CYST

48. THANK YOU