This document provides an introduction to examining the abdomen in clinical skills. It outlines the anatomy and physiology of the abdomen, landmarks, techniques for inspection, auscultation, percussion and palpation. Specific assessment techniques are described for organs like the liver and spleen. Common abdominal disorders and patterns of abdominal pain are also discussed. The goal is to teach medical students how to properly examine the abdomen.

1. Introduction to Clinical Skills The Abdomen Universidad Iberoamericana UNIBE

2. Introduction to Clinical Skills Midterm Exam General appearance Vital signs Integumentary System HEENT and Neck Thorax, Lungs and CVC System Breast and Axillae

3. Introduction to Clinical Skills Teaching Staff Dra Elizabeth Peralta Dr Marcos Núñez Dra Cristina Páez C Dr Juan Carlos Mariñez Dra Wayna Greo Dra Yun Pey Lee

4. Introduction to Clinical Skills The Abdomen: anterior-posterior Anatomy and physiology Landmarks

5. Introduction to Clinical Skills

6. Introduction to Clinical Skills

7. Introduction to Clinical Skills

8. Introduction to Clinical Skills

9. Introduction to Clinical Skills

10. Introduction to Clinical Skills The Abdomen: anterior-posterior Anatomy and physiology Landmarks

11. Introduction to Clinical Skills The Abdomen: Health Promotion and Counseling Screening for alcohol abuse USA: 8.5% population = 17.6 million people CAGE questions Risk factors for Hepatitis A, B, and C Immunizations Transfusions Screening for Colon Cancer PMH: IBD, adenomatous polyps Family history

12. Introduction to Clinical Skills The Abdomen: Health Promotion and Counseling CAGE questions Have you ever felt the need to Cut Down on drinking ? Have you ever fel Annoyed by criticism of your drinking ? Have you ever gelt Guilty about drinking ? Have you ever taken a drink first thing in the morning ( Eye-opener) to steady your nerves or get rid of a hangover ?

13. Introduction to Clinical Skills Gastrointestinal Disorders Abdominal pain, acute and chronic Indigestion, nausea, vomiting, loss of appetite, early satiety Dysphagia and/or odinophagia Change in bowel function Diahrrea, constipation Jaundice Urinary Disorders Suprapubic pain Dysuria, urgency, or frequency Hesitancy, decreased stream in males Polyurea or nocturia Urinary incontinence Hematuria Kidney or flank pain Ureteral colic

14. Introduction to Clinical Skills The Abdomen: Pattern and Mechanisms of Abdominal Pain Visceral pain Hollow viscus distention Solid organs capsule stretch Difficult to localize Parietal pain Inflammation parietal peritoneum More sever, localized Referred pain Distant sites Same spinal nerves as the disordered structures

15. Introduction to Clinical Skills

16. Introduction to Clinical Skills

17. Introduction to Clinical Skills The Abdomen: anterior-posterior Inspection Auscultation Percussion Palpation

18. Introduction to Clinical Skills The Abdomen: anterior-posterior Inspection. Tips for the Examination Empty bladder Supine position, comfortable Flex hips and knees Warm hands and stethoscope Identify painful areas Distraction as necesary

19. Introduction to Clinical Skills The Abdomen: anterior-posterior Inspection Skin: Scars, striae, dilated veins, rashes and lesions Umbilicus: Contour and location Shape-contour; Symmetric, flat scaphoid, prominent Peristalsis (visible) Pulsations (Aorta)

20. Introduction to Clinical Skills The Abdomen: anterior-posterior Auscultation: 4 quadrants Peristalsis Bruits

21. Introduction to Clinical Skills The Abdomen: anterior-posterior Percussion Timpany Dullnes

22. Introduction to Clinical Skills The Abdomen: anterior-posterior Palpation: muscle tone, pain Light palpation Deep palpation Assessment for peritoneal inflammation

23. Introduction to Clinical Skills The Abdomen: anterior-posterior The Liver Percussion Liver span Palpation: right side

24. Introduction to Clinical Skills The Abdomen: anterior-posterior The Liver Percussion Liver span Palpation : right side

25. Introduction to Clinical Skills The Abdomen: anterior-posterior The Spleen Percussion Palpation: left side

26. Introduction to Clinical Skills The Abdomen: anterior-posterior The Kidneys Costovertebral tenderness test Clench fist test Bimanual palpation

27. Introduction to Clinical Skills The Abdomen: anterior-posterior Assessment Techniques for: Ascites Appendicitis Acute cholecystitis Ventral hernia Mass in abdominal wall Pregnancy

28. Introduction to Clinical Skills The Abdomen: anterior-posterior Pelvic Organs Bladder Internal Genitalia Retroperitoneal Organs Kidneys Adrenals Aorta / IVC Thoracolumbar Spine Xifosis Lordosis

29. Introduction to Clinical Skills The Abdomen: anterior-posterior Pelvic Organs Bladder Internal Genitalia Retroperitoneal Organs Kidneys Adrenals Aorta / IVC Thoracolumbar Spine Xifosis Lordosis

30. Introduction to Clinical Skills The Abdomen: anterior-posterior Pelvic Organs Bladder Internal Genitalia Retroperitoneal Organs Kidneys Adrenals Aorta / IVC Thoracolumbar Spine Xifosis Lordosis

31. Introduction to Clinical Skills Recording your findings “ Abdomen is protuberant with active bowel sounds.It is soft and nontender, no palpable masses or heaptosplenomegaly. Liver span is 7cm in the right LCL, edge is smooth and palpable 1 cm below the right costal margin. Spleen and kidneys not felt. No costovertebral angle (CVA) tenderness”

32. Introduction to Clinical Skills