Abdominal Examination PDF

# Abdominal Examination ## Common Complaints * Anorexia * Vomiting * Flatualence * Diarrhoea * Clay colour stool * Black tarry stool * Abdominal pain/lump * Hematemesis * Epistaxis * Nausea * Dysphagia * Retrosternal Burning * Constipation * Worms/mucous in stool * Abdominal distension * Melena *...

# Abdominal Examination ## Common Complaints * Anorexia * Vomiting * Flatualence * Diarrhoea * Clay colour stool * Black tarry stool * Abdominal pain/lump * Hematemesis * Epistaxis * Nausea * Dysphagia * Retrosternal Burning * Constipation * Worms/mucous in stool * Abdominal distension * Melena * Bleeding per rectum ## General Inspection * Nutritional state (wasting) BMI * Pallor * Jaundice (liver disease) * Pigmentation (hemochromatosis) * Mental state (encephalopathy) ## Hands - Nails - Clubbing - Koilonychia - Leuconychia - Palmar erythema - Dupuytren's contractures - Hepatic flap ## Hands - Palmar erythema - Dupuytren's contractures ## Arms * Spider naevi (telangiectatic lesions) * Bruising * Scratch marks (chronic cholestasis) ## Face, Eyes * Conjuctival pallor * Sclera: jaundice * Cornea: Kaiser Fleischer's rings (Wilson's disease) * Xanthelasma (primary biliary cirrhosis) * Parotid enlargement (alcohol) ## ...And Mouth * Fetor Hepaticus - Lips - Angular stomatitis - Cheilitis - Ulceration - Gums - Gingivitis, bleeding - Candida albicans - Pigmentation ## Atrophic glossitis ## Thrush ## Neck And Chest * Cervical lymphadenopathy * Left supraclavicular fossa (Virchow's node) * Gynaecomastia * Loss of hair ## Positioning * Abdomen can be divided in four quadrants * Patient should be lying on supine position ## Regional Division of Abdomen - Epigastric region - Referred pain from foregut - Umbilical region - Referred pain from midgut - Pubic region - Referred pain from hindgut ## Left Upper Quadrant * 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 ## 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 ## 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) ## 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) ## 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 ## Inspection * Shape and movements * Scars * Distension * Prominent veins * Striae * Bruises * Pigmentation * Visible peristalsis - Pyloric stenosis- left to right - Large intestine obstruction- left to right ## Shape - Normal - Pregnancy - Ascites - Fatty Abdomen ## Scars - Kocher incision - Midline incision - McBurney incision - Battle incision - Lanz incision - Paramedian incision - Transverse incision - Rutherford Morrison incision - Pfannenstiel incision ## Abdominal Movement - Normal - Male: Abdomino-thoracic - Female: Thoraco-abdominal - Infant: Thoraco- abdominal - Disease - Diaphragmatic palsy: bulging during expiration - Peritonitis: no movement ## 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 ## Dilated Vein ## Hernial Sites * Epigastric - Upper abdomen - At midline * Incisional - At site of previous surgical incision * Direct inguinal - Near the opening of the inguinal canal * Indirect inguinal - At the opening of the inguinal canal * Umbilical - At the navel * Femoral - Occur in the femoral canal ## 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. ## 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 ## Light Palpation ## Deep Palpation ## 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 ## Murphy's Sign * Pain in RUQ * Inflammation of gallbladder (cholecystitis) ## McBurney's Point * 1/3 ASIS to umbilicus * Location of AV in retrocecal position * Deep tenderness (= acute appendicitis) ## Blumberg's Sign - Rebound tenderness * Pain upon removal of pressure rather than application of pressure to the abdomen * Peritonitis and/or appendicitis ## 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 ## Puddle Sign ## 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. ## 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 ## Splenomegaly * Traube's Space boundaries -Left anterior axillary line, 6th rib, costal margin * Castell's - resonating traube's area ## Bimanual Palpation ## Percussion * Dull sounds: solid or fluid-filled structures * Resonant sounds: structures containing air or gas * Shifting dullness ## Shifting Dullness ## 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 ## Other Examination ## Examination of Hernia ## Per Rectal Examination * Inspection * Palpation ## Few Difference * Ascites - Mysentric cyst * Spleen Lump - Kidney Lump * Ascites - Ovarian Cyst