Abdomen exam

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Abdomen History & Examination

description

an overview of examination of abdomen/tummy for medical students

Transcript of Abdomen exam

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Abdomen

History & Examination

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Important history Dyspepsia- heartburn Dysphagia- difficulty swallowing Altered bowel habit- diarrhea/constipation Pain- colicky, stretch, radiation, referred Bleeding- UGI/LGI Jaundice Urinary symptoms- hematuria, dysuria,

frequency, urgency, hesitancy, retention Appetite Dietary history

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Examination

Oral cavity

Abdomen Male genitalia

Anus/rectum

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Oral cavity

Angular stomatitis, cheilitis Teeth- number, color, ridges, caries Gums- swelling, bleeding, pyorrhea Buccal mucosa- ulcer, pigmentation Tongue- size, color, papillae Palate, tonsils, pharynx

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Abdomen- regions 4- vertical & horizontal planes thru

umbilicus- RUQ, RLQ, LUQ, LLQ 9- vertical planes thru 9th costal cartilage &

femoral artery; horizontal planes are subcostal & interiliac- R & L hypochondrium, lumbar, iliac and epigastrium, umbilical, hypogastrium

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Abdomen- regions

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Quadrants & organs RUQ- liver, GB, upper pole of R

kidney, hepatic flexure of colon LUQ- stomach, spleen, pancreas,

upper pole of L kidney, splenic flexure of colon

RLQ- lower pole of R kidney, appendix, terminal ileum, R colon, R ovary

LLQ- lower pole L kidney, L colon, L ovary

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Pre-examination

Comfortable room & couch Adequate light Patient lying supine Adequate exposure Examiner’s hand at the level of

patient’s abdomen

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Examination- components

Inspection- see, don’t touch

Palpation- touch

Percussion- tap

Auscultation- use stethoscope

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Inspection

Shape- scaphoid, normal, distended Umbilicus- shape, inverted/everted Movements- normal or restricted,

pulsation, visible peristalsis Striae or scars Prominent veins Genitalia & groin

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Palpation

Relaxed patient & abdominal wall Start from the point farthest from

possible area of involvement e.g. for liver start from LLQ & for spleen from RLQ

Palpate whole abdomen in an order

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Special techniques

Deep palpation- in obese, muscular or poorly relaxed

Dipping- tense ascites Bimanual- for kidney & spleen Ballotable- kidney Shifting dullness & fluid thrill- for

ascitis

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It helps Spleen L hypochondrium Grows towards RLQ Upper border not

reached Moves with

respiration Medial notch Not ballotable Dull on percussion

L kidney Renal angle posteriorly Grows towards LLQ Upper border

reachable Restricted mobility No notch Ballotable Colon overlying on

percussion

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Liver

RUQ Moves with respiration Tender or not? Edge- soft, firm, hard Surface- smooth, nodular Pulsatile in TR Confirm span by percussion

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Gall bladder

Underlies liver in RUQ Moves with respiration Usually not palpable Tender- Murphy’s sign- +ve in

acute cholecystitis Palpable GB- mucocoele, cancer,

CBD obstruction

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Urinary bladder

Midline, suprapubic Usually not palpable When palpable- smooth,

symmetrical, lower border not reached,

Urge to micturate on palpation Dull on percussion

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Percussion

Only light percussion required

Resonant note allover, except over liver where it is dull

Used to confirm liver or spleen or bladder enlargement & ascitis

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Auscultation

Paraumbilical For bowel sounds or bruit Normal BS- intermittent gurgles

interspersed with tinkles Increased- intestinal obstruction Decreased- paralytic ileus Bruit- over aorta, iliac/renal arteries

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Don’t forget

Groin- LNE, hernia

Male genitalia

PR examination- for local pathology, prostate examination in males

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Stigmata of CLD Muscle wasting Pallor, jaundice Clubbing Palmar erythema Dupuytren’s contracture Spider nevi Gynecomastia Testicular atrophy Caput medusae Ascites

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Supported by

X-ray, US/CT, Endoscopy