This document provides guidance on performing an abdominal examination. It outlines the major steps which include inspection, palpation, percussion, and auscultation. Inspection involves examining the patient's abdomen for distension, scars, pulsations, peristalsis and masses. Common causes of distension are discussed. Inspection of the umbilicus and visible veins is also described. The document provides details on evaluating abdominal scars and stomas and their potential complications.

1. ABOMINAL EXAMINATION
Dr. W. Elkatib

2. ABOMINAL EXAMINATION
CAN ANYONE PRACTISE MEDICINE???

3. MAJOR STEPS
1. Inspection
2. Palpation
3. Percussion
4. Auscultation
5. Associated things related to abdomen

4. INSPECTION
1. Self introduction and permission to exam
2. Patient position:
supine with a pillow to support the head with measures
to relax abdominal wall muscles.
3. Exposure:
From midchest to midthighs or to genitals if embarrassing.
Look at end of bed for:
4. Abdominal distension and symmetry.. Specify which part of
abdomen is distended if asymmetrical

5. INSPECTION
CAUSES OF ABDOMINAL
DISTENSION(6 Fs)
A line between pubis and
xiphoid in supine patient
can roughly detect
distension.
• Fat (obesity)
• Faeces
• Flatus
• Foetus (pregnancy)
• Fluid (ascites)
• Fibroid and other
tumours

6. INSPECTION
5. Umbilicus morphology.
Normally inverted and
abnormal if
❑Everted in distension and
umbilical hernia.
❑Crescent-shaped in paraumbilical
hernia.
❑Rarely tumour (Sister Joseph’s
sign), pyogenic granuloma,
endometriosis, and pilonidal
sinus are seen

7. SISTER
JOSEPH’S
SIGN
A FEATURE OF
INTRAABDOMINAL
MALIGNANCY
AS IN COLON,
GASTRIC, &
PANCREATIC CANCERS

8. UMBILICAL MORPHOLOGY

9. INSPECTION
5. Type of respiration
…Abdominothoracic in males
….Thoracoabdominal in females and athletics.
Then go the right side of the bed and kneel
down to level of the abdomen, ask patient to
hold his breath, and look for against
illumination:
7. Pulsation.. Visible in thin patient and
most prominent in aneurysm.
8. Peristalsis.. Visible in intestinal
obstruction in thin patient.
9. Abdominal movement.. Absent in
peritonism.

10. INSPECTION
10.Then stand up and look for:
Scars and Incisions. Each
scar should be
anatomically named and its
phase
Inflammatory
Proliferative
Maturation & remodeling

11. SURGEONS PREFER POLITICIAN PATIENTS

12. INSPECTION
10. Scars and Incisions:
On other hand, you need to
know site, and method and
material of closure of any
incision (sutures, staples,
glue..etc)

13. METHODS OF SUTURING TECHNIQUES
❑ CONTINUOUS (LOCKED OR
UNLOCKED)
❑ SUBCUTICULAR (INTERRUPTED
OR CONTINUOUS)
❑ SIMPLE INTERRUPTED
❑ MATTRESS (VERTUICAL OR
TRANSVERSE)
SUTURE MATERIAL:
➢ ABSORBABLE VS NONABSORSABLE
➢ NATURAL VS SYNTHETIC
➢ MONOFILAMENT VS MULTIFILAMENT
➢ COATED OR DYED
➢ BRAIDED OR TWISTED

14. SURGEONS AND CHOICE OF INCISIONS

15. TYPES OF TRUNK INCISIONS
➢Vertical: Midline, paramedian, median
sternotomy….etc
➢Transverse: Pfannesteil, Lanz, Morris.
Paraumbilical….etc
➢Oblique: Kocher, Gridiron, groin, Rutherford-Morrison,
Gibson, Rooftop, Lateral thoracotomy…..etc
➢Stab incision for drains and laparoscopic trocars
➢Nonsurgical scar: Traumatic, burns, gafts..etc

16. COMMON SURGICAL INCISIONS

17. VERTICAL INCISIONS & SCARS
TYPES
1. MIDLINE (FULL, UPPER, OR LOWER)
2. PARAMEDIAN (FULL, UPPER, OR
LOWER, & RIGHT OR LEFT)
3. MODIFICATIONS OF PARAMEDIAN:
❑ BATTLE (TRANSRECTAL OR PARARECTAL)
❑ MAYO-ROBSON (UPPER END EXTENDED MEDIALLY
TOWARD XIPHISTERNUM)
❑ KEHR’S (UPPER END EXTENDED LATERALLY AS
KOCHER)

18. TRANSVERSE INCISIONS &
SCARS
TYPES
1. PFANNESTEIL (SUPRAPUBIC)
2. UPPER & LOWER TRANSVERSE
3. MODIFICATIONS OF PFANNESTEIL
❑ CHERNEY (CUT TENDONS OF RECTI)
❑ MAYLARD ( CUT MUSCLE FIBRES OF RECTI
❑ ABDOMINOPLASTY INCISION

19. OBLIQUE INCISIONS & SCARS
TYPES
1. LATERAL THORACOTOMY
2. KOCHER (SUBCOSTAL)
3. GRIDIRON
4. LOIN (MORRIS)
5. ROOF TOP
6. GABLE (MERCEDES BENZ)
7. GIBSON
8. GROIN (INGUINAL)
9. RUTHERFORD MORRISON

20. OBLIQUE INCISIONS & SCARS
TYPES
1. LATERAL THORACOTOMY
2. KOCHER (SUBCOSTAL)
3. GRIDIRON
4. LOIN (MORRIS)
5. ROOF TOP
6. GABLE (MERCEDES BENZ)
7. GIBSON
8. GROIN (INGUINAL)
9. RUTHERFORD MORRISON

21. APPENDICECTOMY SCARS
❑McBURNEY (GRIDIRON)
❑LANZ
❑ROCKEY DAVIS
❑RIGHT LOWER PARAMEDIAN
❑LOWER MIDLINE
❑LAPAROSCOPIC
❑RUTHERFORD-MORRISON

22. LAPAROSCOPIC INCISIONS
❑LAP. APPENDICECTOMY
❑LAP. CHOLECYSTECTOMY
❑LAP. NEPHRECTOMY
❑LAP. SPLENECTOMY
❑LAP. HYSTERECTOMY
❑LAP. SLEEVE GASTRECTOMY

23. LAPAROSCOPIC INCISIONS
❑LAP. APPENDICECTOMY
❑LAP. CHOLECYSTECTOMY
❑LAP. NEPHRECTOMY
❑LAP. SPLENECTOMY
❑LAP. HYSTERECTOMY
❑LAP. SLEEVE GASTRECTOMY

24. EARLY WOUND
COMPLICATIONS
❑HAEMATOMA
❑SEROMA
❑INFECTION
❑PARTIAL DEHISCENCE
❑COMPLETE DEHISCENCE
❑MELENEY GANGRENE

25. EARLY WOUND
COMPLICATIONS
❑HAEMATOMA
❑SEROMA
❑INFECTION
❑PARTIAL DEHISCENCE
❑COMPLETE DEHISCENCE
❑MELENEY GANGRENE

26. LATE WOUND
COMPLICATIONS
❑HYPERTROPHIC SCAR
❑KELOID SCAR
❑INCISIONAL HERNA

27. Name the following incisions

28. 11- STOMAS
TYPES
A. Viscus involved: ileum, colon,
bladder, ureter, oesophagus,
urinary diversion or
conduit…etc
B. Duration: temporary versus
permanent.
C. Method of construction: end,
loop, mucous fistula, double
barreled.

29. COMMON STOMAS
➢Ileostomy: small stoma, end or
loop, RIF- located, nippled,
inflamed surrounding skin,
with fluid effluent and larger
collection bag
➢Colostomy: larger stoma, end,
loop, or double barreled, LIF-
located, flushed with skin,
normal surrounding skin, with
solid or semisolid effluent with
smaller collection bag

30. STOMAS
COMPLICATIONS
❑BLEEDING
❑NECROSIS/GANGRENE
❑RETRACTION
❑PROLAPSE
❑SKIN DERMATITIS
❑ENTEROCOLITIS
❑PARASTOMAL HERNIA

31. STOMAS
COMPLICATIONS
❑BLEEDING
❑NECROSIS/GANGRENE
❑RETRACTION
❑PROLAPSE
❑SKIN DERMATITIS
❑ENTEROCOLITIS
❑PARASTOMAL HERNIA

32. STOMA CONSTRUCTION/ FASHIONING
❑LOOP STOMA
❑END STOMA THAT IS FURTHER
DIVIDED ACCORDING TO THE DISTAL LOOP
CONSTRUCTION
➢HARTMANN’S PROCEDURE
➢ END STOMA + MUCOUS
FISTULA
➢DOUBLE BARRELED

33. STOMA CONSTRUCTION/
FASHIONING
❑LOOP STOMA
❑END STOMA THAT IS FURTHER
DIVIDED ACCORDING TO THE DISTAL LOOP
CONSTRUCTION
➢HARTMANN’S PROCEDURE
➢ END STOMA + MUCOUS
FISTULA
➢DOUBLE BARRELED

34. 12- Visible abdominal masses
May be:
❖ Abdominal wall
❖Intraperitoneal
❖Retroperitoneal
❖Hernias

35. HERNIAS CHARACTERISTICS
➢Characteristic site :
❑ Groin (Inguinal, femoral, and obturator)
❑ Ventral (umbilical, paraumbilical, epigastric, and spigellian)
❑ Incisional (including parastomal).
➢Reducibilty in early stages
➢Positive cough impulse in early stages
➢Visceral organs or extrapeitoneal fat content
➢Pressure control if reducible

36. VARIOUS ABDOMINAL MASSES

37. 13- DILATED ABDOMINAL VEINS
13-Visible dilated veins…
Around umbilicus called Caput
medusa in portal hypertension,
At lateral abdominal and chest
walls in SVC and IVC obstruction
(two fingers test)

38. 14- STRIA …
3 Types
➢Pink: in recent abdominal wall
distension, rapid weight gain or
loss.
➢White: old stria
➢Purpule: in Cushing’s syndrome
or steroid use.

39. DO WE STILL CARE FOR OUR PATIENTS