This document provides guidance on performing a surgical abdominal examination. Key steps include: 1. Examining the patient in a supine position and inspecting the abdomen for distension, masses, scars, and symmetry. Palpate the abdomen in three ways - superficial, deep, and organ palpation - to check for tenderness, masses, and organ enlargement. 2. When palpating the liver, percuss along the midclavicular line to determine the liver edge and check for irregularity or tenderness. Palpate the spleen for enlargement. Use two hands to palpate each kidney. 3. Perform percussion over all nine abdominal regions and check for shifting

1. SURGICAL ABDOMINAL EXAMINATION
1. Must examine insittingunlessyouare aspecialist
2. Anydiagnosis
a. Etiology
b. Predisposing
c. Clinical feature (primaryand2nd
complication)
d. Investigation
e. Management
3. Acute abdomentargetPRO
a. Acute appendicitis
b. Acute pancreatitis
c. Cholangitis
4. Thingmust knowbydr saw insurgery
a. History
b. GPE
c. Abdomen
d. Mass examination
e. Ulcer examination
PER ABDOMEN EXAMINATION
Must 5
1. Consent
2. Privacy
3. Chaperon
4. Position
a. Bestis supine (allowonly1pillow)
b. Prop-upposition(10to 45 degree only)
c. Patienthandmustbe at side (notonchest/abdomen/behindhead)
5. Exposure
a. Normal (nipple line till midthighbutisAsian/cultural xiphi till pubicsymphysisje)

2. Start!
INSPECTION
1. Duduk!Must eye level dengan patientabdomenandatright side
2. Look abdominal shape (imaginaryline fromcostal toiliaccreast)
a. Distended
b. Flat
c. Scaphoid(boat/sampan)
3. Standup and go at bedside,commenton5 thing
a. Umbilical
b. Symmetry
c. Flank
d. Mass
e. Move withrespiration
4. Thendudukbalik di side,commentotherfinding
a. Scar
b. Peristalsis
c. Hair
d. Pigmentationyadayada
e. JANGAN LUPA COUGH REFLEX! Lookat tempat
i. Umbilical
ii. Periumbilical
iii. Scar
iv. epigastric
5. palpation,atside balik,duduk!,ada3jenispalpation
a. superficial
b. deep
c. organ

3. PALPATION
1. see tenderness
2. palmup/musthorizontal arm,palpate temperature all 9REGION (not9 QUADRANT)
superficialpalpation (lookatface)
1. consistency
2. tenderness
a. if +, do reboundtenderness(verbaldemonstration)
b. if -, dorigidityandguarding
deep palpation (lookatface,kalau kau besar,guna 1 tangan,kalau kau kecikguna 2 tangan),
dipping method only in ascitesto see liver
1. mass
a. kalauada mass,pulsationkenacheck(transmittedorexpansile)
organ palpation
LIVER
1. Explaintopatientwhatyourgonna do
2. Askhimto breathdeeplyandregularly
3. Start of rif,handradial borderparallel tocostal (tunjuksikitkaumeasure parallel di costal tu
thenke RIF),move cm by cm to liver
4. Jumpalowerborder,mintapatientholdby hisfinger
5. Thenpercussalongmidclavicularat 2nd
ICS till liverdullness,thenmeasure andcomment
enlarge ke tidak(showmanshipcari sternal angle!)
6. If liverenlarge doesnotmeanitenlarge,commenton
a. Surface (regular,irregular)
b. Edge (sharp,blunt)
c. Tenderness
SPLEEN
1. Explaintopatientwhatyourgonna do
2. Askhimto breathdeeplyandregularly
3. Use ur handstart at rif,fingerparalleltorectusmuscle
4. Move towardtraube area (spleen)
5. Kalauspleenfeltmeandah2-3x enlarge
6. Kalaux palpable
a. Pressdown
b. Put patientinlateral
c. Percuss

4. KIDNEY
1. Explaintopatientwhatyourgonna do
2. Askhimto breathdeeplyandregularly
3. Ada 2 hand (watchinghand – atas , ballothand - bawah)
4. Renal angle (betweenerectorspinae and12th
rib)
Differentiatebetween renal and spleen/renaland liver mass
PERCUSSION
1. All 9 region
2. Checkshiftingdullness
a. Positive shiftingdullness
b. Fixeddullness(nonegativedullnessinthisuniverse)
AUSCULTATION
1. All 9 regionauscultate
2. Postop/laparotomy
a. Day 1, at terminal ileum, 2cm rightlateral of umbilicus
b. Day 2, over gastricarea
c. Day 3 , Tanya dahpass flatuske
3. Renal/aorticyadabruit
4. All mustlistenfor1 min