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Examination of Abdomen
Dr Santosh Kumar Singh
Assistant Professor
Department of Pediatrics
18.02.2019
1.Right
hypochondrium:
Liver, gallbladder
and large colon
3.Left hypochondrium:
Spleen, colon
2. Epigastrium:
Stomach, pancreas,
left lobe of liver
4.Right lumbar:
Right kidney, large
colon 6.Left lumbar: Left
kidney, large colon
5 Umbilical: Small
intestine
7 .Right iliac:
Large bowel
8.5uprapubic:
Urinary bladder
9.Left iliac: large
bowel,rectum
Contents of 9 Regions of Abdomen
General Examination Relevant to Abdomen
1. Jaundice
2. Pallor -anaemia
3. Lymphadenopathy- TB, leukemia, lymphoma
5. Signs of liver cell failure- jaundice, palmer erythema,
6. Edema and dehydration
7. Clubbing
9. Bony tenderness
10.Nutritional status
11.Eye & Oral cavity
Examination of the Abdomen-position
Examining an infant in the mother’s lap toddler in standing position.
A. Inspection of the Abdomen
1.Shape of the abdomen-fullness, protuberant,
localized distension, scaphoid abdomen
2.Abdominal movements
3.Umbilicus: Position and shape everted, hernia
4.Skin scars or incision
5.Superficial dilated veins- blood flow direction.
6.Visible peristalsis
7.Groins and scrotum
B. Palpation
• Ask the child to lie supine with the hip joints
flexed and arms by the side.
• Ask the child to relax.
• Position your forearm horizontally along
the abdomen and place the fingers flat on
the abdominal wall.
• Press inwards during expiration and allow
passive outward movement during inspiration.
a. Light Palpation
• Rigidity and guarding will be felt in children
with peritonitis / perforation,
• Tense abdomen – distention due to gas/ fluid.
• Rebound tenderness – peritonitis
b. Deep Palpation -Liver, Spleen, Kidney
Characteristics of Liver
1. Size: Normal liver span-
Infants : 5—6.5 cm;
1—5 years : 6—7 cm;
5—10 years : 7—9 cm;
10—1 5 years : 8—10 cm.
2. Surface
3. Consistency
4. Margins
5. Tenderness
Common causes of Hepatomegaly
Infants
Intrauterine infections, like TORCH
group of infections
Septicemia
Neonatal hepatitis
Biliary obstruction
Glycogen storage disorder
Galactosemia
Alpha-i-antitrypsin deficiency
Congestive cardiac failure
Older children
Fatty liver—as in malnutrition
Hepatic abscess: Bacterial or amebic
Lipid storage disorders: Gaucher, Niemann-
Pick disease
Glycogen storage disorders
Hepatitis (acute or chronic)
Tuberculosis
Malignancies Leukemia, lymphoma,
neuroblastoma,and hepatoblastoma
Metabolic diseases Alpha-i-antitrypsin
deficiency, cystic fibrosis, Wilson disease
Congestive cardiac failure, constrictive
pericarditis,
Hemolytic anemia
Veno-occlusive disease,
Extrahepatic obstruction
Spleen
Palpation of spleen in right lateral position.
Palpation of spleen
Size:
• Mildly enlarged- palpable 1—2 cm below costal margin.
• Moderately enlarged- palpable 3—7 cm below the costal margin.
• Massive enlargement - palpable >7 cm below the costal margin or crosses
the umbilicus
Consistancy;
Splenic Notch: notch an indentation on the lower medial border of spleen.
Common causes of splenomegaly
• Infections: Typhoid, malaria, endocarditis,
septicemia, abscess, toxoplasma,
cytomegalovirus, kala-azar
• Hematologic : Hemolytic anemias, leukemia,
lymphoma, hemangioma
• Infiltrative : Lipid storage disorders (Niemann-
Pick and Gaucher)
• Congestive: Cirrhosis, portal hypertension,
congestive cardiac failure.
• Miscellaneous : SLE
Kidney
Palpation of right kidney.
Palpation of left kidney.
Renal Lump and Spleen
1. Spleen is not bimanually palpable.
2. Upper border of spleen cannot be reached.
3. Upper border can be felt in a renal lump.
3. Direction of enlargement of spleen is towards
the right iliac fossa.
4. Massive spleen can cross the midline, but a
renal lump will not cross the umbilicus.
5. Splenic notch - confirms the presence of a
spleen.
Abdominal lump
• Site and origin: lump is intra-abdominal or
parietal.
(a) Patient lifting his shoulders off the couch (l b) straight leg raising test.
Description of an Abdominal Lump
1. Site Which regions are being occupied by the
lump?
2. Origin Intra—abdominal or parietal
3. Size Both in vertical and horizontal planes
4. Shape Round, elongated, or irregular
5. Margins : well or ill-defined.
6. Surface Smooth or nodular
7. Consistency Cystic, firm, or hard
8. Mobility Moving with respiration or otherwise
9. Ballotability
10. Signs of inflammation- present / absent
C. Percussion
• Gaseous distension: abdominal distention is due to gas
or fluid.
• In presence of gas in the abdomen, the overlying
percussion note will be resonant or tympanic.
• Masking of liver dullness : Percussion over the liver
normally yields a dull note. In intestinal perforation,
there is accumulation of gas between the diaphragm
and liver. The liver is displaced inferiorly. The usual area
overlying the liver (which should have been dull)
becomes resonant.
• Presence of fluid in the peritoneal cavity will result in
different findings depending upon the amount of fluid
present.
• Puddle Sign Shifting Dullness
Demonstration of fluid thrill
D. Auscultation
• Bowel sounds: exaggerated in intestinal
obstruction, silent in ileus or peritonitis.
• A renal bruit : in renal artery stenosis,
hypertension or arteritits .
• A venous hum : audible over liver or
spleen in case of vascular tumors
E. Genitalia
• Hernial sites, undescended or retractile testis,
ambiguous genitalia, testicular swelling, and
inflammation.
• The urethral opening should be examined for
stenosis, hypospadias, epispadias, chordee (shaft
of penis is curved), phimosis, and penile length.
• Phimosis is inability to retract the prepuce and
may be physiological till 18—24 months of age.
• If the urethra opens on the dorsal surface of the
penis, this is called epispadias and if it opens on
the ventral surface, it is known as hypospadias.
.
ABDOMEN
Inspection:
• Shape ---------Prominent Veins ---------Umbilicus – normal / Everted /
other findings---------Peristalsis
Palpation:
• General (Lump / Lumps / Presents / Not Present ( Details to be noted)
• LIVER:Size……Shape…Surface…Consistency---Border…
tenderness…. Pulsatile / non pulsatile…Margins… Liver span (cm)
• Spleen Kidney
• Glands Colon
• Genital Examination
• Rectal Exam
PERCUSSION:
• Free Fluid
• Liver Upper Border…….Lower Border…Bladder -----
AUSCULTATION:
• Bowel sounds
Thank You

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Examination of Abdomen.pptx

  • 1. Examination of Abdomen Dr Santosh Kumar Singh Assistant Professor Department of Pediatrics 18.02.2019
  • 2. 1.Right hypochondrium: Liver, gallbladder and large colon 3.Left hypochondrium: Spleen, colon 2. Epigastrium: Stomach, pancreas, left lobe of liver 4.Right lumbar: Right kidney, large colon 6.Left lumbar: Left kidney, large colon 5 Umbilical: Small intestine 7 .Right iliac: Large bowel 8.5uprapubic: Urinary bladder 9.Left iliac: large bowel,rectum Contents of 9 Regions of Abdomen
  • 3.
  • 4. General Examination Relevant to Abdomen 1. Jaundice 2. Pallor -anaemia 3. Lymphadenopathy- TB, leukemia, lymphoma 5. Signs of liver cell failure- jaundice, palmer erythema, 6. Edema and dehydration 7. Clubbing 9. Bony tenderness 10.Nutritional status 11.Eye & Oral cavity
  • 5. Examination of the Abdomen-position Examining an infant in the mother’s lap toddler in standing position.
  • 6. A. Inspection of the Abdomen 1.Shape of the abdomen-fullness, protuberant, localized distension, scaphoid abdomen 2.Abdominal movements 3.Umbilicus: Position and shape everted, hernia 4.Skin scars or incision 5.Superficial dilated veins- blood flow direction. 6.Visible peristalsis 7.Groins and scrotum
  • 7. B. Palpation • Ask the child to lie supine with the hip joints flexed and arms by the side. • Ask the child to relax. • Position your forearm horizontally along the abdomen and place the fingers flat on the abdominal wall. • Press inwards during expiration and allow passive outward movement during inspiration.
  • 8. a. Light Palpation • Rigidity and guarding will be felt in children with peritonitis / perforation, • Tense abdomen – distention due to gas/ fluid. • Rebound tenderness – peritonitis b. Deep Palpation -Liver, Spleen, Kidney
  • 9. Characteristics of Liver 1. Size: Normal liver span- Infants : 5—6.5 cm; 1—5 years : 6—7 cm; 5—10 years : 7—9 cm; 10—1 5 years : 8—10 cm. 2. Surface 3. Consistency 4. Margins 5. Tenderness
  • 10. Common causes of Hepatomegaly Infants Intrauterine infections, like TORCH group of infections Septicemia Neonatal hepatitis Biliary obstruction Glycogen storage disorder Galactosemia Alpha-i-antitrypsin deficiency Congestive cardiac failure Older children Fatty liver—as in malnutrition Hepatic abscess: Bacterial or amebic Lipid storage disorders: Gaucher, Niemann- Pick disease Glycogen storage disorders Hepatitis (acute or chronic) Tuberculosis Malignancies Leukemia, lymphoma, neuroblastoma,and hepatoblastoma Metabolic diseases Alpha-i-antitrypsin deficiency, cystic fibrosis, Wilson disease Congestive cardiac failure, constrictive pericarditis, Hemolytic anemia Veno-occlusive disease, Extrahepatic obstruction
  • 11. Spleen Palpation of spleen in right lateral position. Palpation of spleen Size: • Mildly enlarged- palpable 1—2 cm below costal margin. • Moderately enlarged- palpable 3—7 cm below the costal margin. • Massive enlargement - palpable >7 cm below the costal margin or crosses the umbilicus Consistancy; Splenic Notch: notch an indentation on the lower medial border of spleen.
  • 12. Common causes of splenomegaly • Infections: Typhoid, malaria, endocarditis, septicemia, abscess, toxoplasma, cytomegalovirus, kala-azar • Hematologic : Hemolytic anemias, leukemia, lymphoma, hemangioma • Infiltrative : Lipid storage disorders (Niemann- Pick and Gaucher) • Congestive: Cirrhosis, portal hypertension, congestive cardiac failure. • Miscellaneous : SLE
  • 13. Kidney Palpation of right kidney. Palpation of left kidney.
  • 14. Renal Lump and Spleen 1. Spleen is not bimanually palpable. 2. Upper border of spleen cannot be reached. 3. Upper border can be felt in a renal lump. 3. Direction of enlargement of spleen is towards the right iliac fossa. 4. Massive spleen can cross the midline, but a renal lump will not cross the umbilicus. 5. Splenic notch - confirms the presence of a spleen.
  • 15. Abdominal lump • Site and origin: lump is intra-abdominal or parietal. (a) Patient lifting his shoulders off the couch (l b) straight leg raising test.
  • 16. Description of an Abdominal Lump 1. Site Which regions are being occupied by the lump? 2. Origin Intra—abdominal or parietal 3. Size Both in vertical and horizontal planes 4. Shape Round, elongated, or irregular 5. Margins : well or ill-defined. 6. Surface Smooth or nodular 7. Consistency Cystic, firm, or hard 8. Mobility Moving with respiration or otherwise 9. Ballotability 10. Signs of inflammation- present / absent
  • 17. C. Percussion • Gaseous distension: abdominal distention is due to gas or fluid. • In presence of gas in the abdomen, the overlying percussion note will be resonant or tympanic. • Masking of liver dullness : Percussion over the liver normally yields a dull note. In intestinal perforation, there is accumulation of gas between the diaphragm and liver. The liver is displaced inferiorly. The usual area overlying the liver (which should have been dull) becomes resonant. • Presence of fluid in the peritoneal cavity will result in different findings depending upon the amount of fluid present.
  • 18. • Puddle Sign Shifting Dullness Demonstration of fluid thrill
  • 19. D. Auscultation • Bowel sounds: exaggerated in intestinal obstruction, silent in ileus or peritonitis. • A renal bruit : in renal artery stenosis, hypertension or arteritits . • A venous hum : audible over liver or spleen in case of vascular tumors
  • 20. E. Genitalia • Hernial sites, undescended or retractile testis, ambiguous genitalia, testicular swelling, and inflammation. • The urethral opening should be examined for stenosis, hypospadias, epispadias, chordee (shaft of penis is curved), phimosis, and penile length. • Phimosis is inability to retract the prepuce and may be physiological till 18—24 months of age. • If the urethra opens on the dorsal surface of the penis, this is called epispadias and if it opens on the ventral surface, it is known as hypospadias. .
  • 21. ABDOMEN Inspection: • Shape ---------Prominent Veins ---------Umbilicus – normal / Everted / other findings---------Peristalsis Palpation: • General (Lump / Lumps / Presents / Not Present ( Details to be noted) • LIVER:Size……Shape…Surface…Consistency---Border… tenderness…. Pulsatile / non pulsatile…Margins… Liver span (cm) • Spleen Kidney • Glands Colon • Genital Examination • Rectal Exam PERCUSSION: • Free Fluid • Liver Upper Border…….Lower Border…Bladder ----- AUSCULTATION: • Bowel sounds