Post on 07-Jul-2018
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THORAX-ABDOMINAL EXAMINATION
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CHEST TOPOGRAPHY:
ANTERIOR CHEST
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CHEST TOPOGRAPHY:LATERAL CHEST
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CHEST TOPOGRAPHY:POSTERIOR CHEST
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FISSURES:
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LOCATION OF LOBES
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Observation
PalpationPercussion
Auscultation
PHYSICAL EXAMTECHNIQUES
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Patient ‘s surroundings, ie: the view from the door
Equipment present
Posted signsSPUTUM!
OBSERVATION
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Eupnea
Tachypnea/BradypneaBiot’s
Cheynes!to"es
#uss$aul
OBSERVATION:BREATHING PATTERNS
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OBSERVATION:THORACIC CONTOUR
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Pectus E%cavatu$
Pectus Carinatu$
#yphosis&ordosis!coliosis
#yphoscoliosis
!y$$etry o' chest $ove$ent
OBSERVATION: THORACIC CONTOUR (CONT.)
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OBSERVATION: CLUBBING
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PALPATION: TRACHEAL ALIGNMENT
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Pneu$othora% ( shi'ts to una)ected side
Pleural E)usion ( shi'ts to una)ected side
*ibrosis or Atelectasis ( shi'ts to+ardsa)ected side
Pul$onary consolidation ( no shi't
TRACHEAL ALIGNMENT ABNORMALITIES
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PALPATION : CHESTEXCURSION
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PERCUSSION
Assess density o'underlying tissue
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-esonance ( nor$al
.ullness ( increased density
Atelectasis, alveolar lling/consolidation,pleural e)usion, brosis
0yperresonance ( decreased density
0yperin1ation 2COP.3, Pneu$othora%
PERCUSSION NOTES
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ABDOMINAL EXAM
Abdo!"#$E%#!"#&!o"
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0istory
Anato$y
PhysicalPractice cases
gastrointestinal co$plaints
4or" on incorporating 5 into history andphysical e%a$ s"ills
Practice docu$entation
AGENDA
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Abdo$inal pain
Change in appetite.ysphagia/Odynophagia
.i)icult or pain'uls+allo+ing
6ausea/7o$iting
8aundice
Change in bo+el
habits9elena/0e$atocheia
.ar" tarry or redstools
0e$orrhoids
Anal pruritis
Coo" Co'$#!"&:
*
HISTORY
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R+,!o" (A"#&o!#$) Q#d/#"& (C$!"!#$)
ANATOMY
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SURFACE ANATOMY
0
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E$pty bladder
Patient co$'ort 2pillo+s and draping3
Ar$s at side or crossed over chest
As" the patient to point to any pain'ul areas; e%a$ine last
4ar$ hands and stethoscope
Tic"lish or nervous patients: slo+ $ove$ents, distraction,use their hands
ENHANCING THE EXAM
1
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nspection
Auscultation
Percussion or palpation can alter bo+el sound 're
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Contour
*lat
!caphoid
.istended
!y$$etry
9ove$ent
Peristaltic-espirations
Aortic pulsation
!"in
!cars ( cicatri%
!triae
.iscoloration
7enous patterns
Ede$a
3
ABDOMINAL PHYSICALEXAM
INSPECTION
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6otes Elicited
Ty$panic
Predo$inant due to gas in 5 tract
0yperresonant
.ull
Organs, 1uid and 'eces
*lat
.istension o' abdo$en*luid vsF Air
Outline Organs
&iver, spleen, and gastric bubble
ABDOMINAL PHYSICALEXAM
PERCUSSION
5
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!tart 'arthest 'ro$ pain and $ove to+ards it
abdo$inal
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&iver: le't lobe
!pleen
!to$ach
8eGunu$ and pro%i$alileu$
Pancreas: body andtail
&e't "idney&e't suprarenal gland
&e't colic 2splenic31e%ure
Transverse colon: le't07
ABDOMINAL PHYSICALEXAMPALPATION - LEFT UPPERQUADRANT
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&iver: le't lobe!pleen!to$ach
8eGunu$ and pro%i$alileu$Pancreas: body and tail&e't #idney&e't !uprarenal gland
&e't colic 2splenic3 1e%ureTransverse colon: le't hal' .escending colon:superior part
0*
Abdo$inal Physical E%a$
Palpation &e't Hpper =uadrant
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&iver: right lobe5allbladder!to$ach: pylorus
.uodenu$: parts IPancreas: head-ight suprarenal gland-ight "idney-ight colic 2hepatic3 1e%ure Ascending colon: superior
partTransverse colon: right hal'
0
ABDOMINAL PHYSICALEXAMPALPATION - RIGHT UPPER
QUADRANT
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&iver: right lobe5allbladder ( 9urphy’s sign!to$ach: pylorus
.uodenu$: parts IPancreas: head-ight suprarenal gland-ight "idney-ight colic 2hepatic3 1e%ure Ascending colon: superiorpartTransverse colon: right hal'
00
ABDOMINAL PHYSICAL EXAMPALPATION - RIGHT UPPER QUADRANT
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Cecu$ 7er$i'or$ appendi%
9cBurney’s point
-ovsing’s sign
Psoas sign
Obturator sign
9ost o' ileu$ Ascending colon: in'erior part-ight ovary
-ight uterine tube-ight sper$atic cordHterus 2i' enlarged3Hrinary bladder 2i' 'ull3
01
ABDOMINAL PHYSICALEXAMPALPATION - RIGHT LO8ER
QUADRANT
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02
Walgreens.com
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!ig$oid colon
.escending colon:in'erior part
&e't ovary&e't uterine tube
&e't ureter: abdo$inalpart
&e't sper$atic cord:abdo$inal part
Hterus 2i' enlarged3
Hrinary bladder 2i' 'ull3
03
ABDOMINAL PHYSICALEXAMPALPATION - LEFT LO8ERQUADRANT
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!ig$oid colon
.escending colon: in'eriorpart
&e't ovary&e't uterine tube
&e't ureter: abdo$inalpart
&e't sper$atic cord:
abdo$inal partHterus 2i' enlarged3
Hrinary bladder 2i' 'ull3
04
ABDOMINAL PHYSICALEXAMPALPATION - LEFT LO8ERQUADRANT
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Abdo$inal Aortanguinal &y$ph
6odesCostovertebral
angle 2C7A3tenderness
EXTRAS
05
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•nspection
–Contour
–!"in
–
9ove$ent• Auscultation
–Bo+el sounds
– 7ascular sounds
•Percussion
–
Abdo$en 'or $asses or 1uid –&iver span
–!pleen
–5astric bubble
•Palpate
–5eneral palpation
–&iver
–5allbladder
–!pleen
–- and & "idneys
– Abdo$inal aorta
–nguinal ly$ph nodes
•!pecial:
–9urphy’s sign
–9cBurney’s point
–-ovsing’s sign
–Psoas sign
–Obturator sign
–-ebound tenderness06
ABDOMINAL PHYSICAL EXAMPRACTICE- 7 MINUTES