Abdomen exam

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an overview of examination of abdomen/tummy for medical students

Transcript of Abdomen exam

  • 1.Abdomen History & Examination

2. 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 3. Examination Oral cavity Abdomen Male genitalia Anus/rectum 4. 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 5. 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 6. Abdomen- regions 7. 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 8. Pre-examination Comfortable room & couch Adequate light Patient lying supine Adequate exposure Examiners hand at the level of patients abdomen 9. Examination- components Inspection- see, dont touch Palpation- touch Percussion- tap Auscultation- use stethoscope 10. Inspection Shape- scaphoid, normal, distended Umbilicus- shape, inverted/everted Movements- normal or restricted, pulsation, visible peristalsis Striae or scars Prominent veins Genitalia & groin 11. 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 12. 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 13. 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 14. Liver RUQ Moves with respiration Tender or not? Edge- soft, firm, hard Surface- smooth, nodular Pulsatile in TR Confirm span by percussion 15. Gall bladder Underlies liver in RUQ Moves with respiration Usually not palpable Tender- Murphys sign- +ve in acute cholecystitis Palpable GB- mucocoele, cancer, CBD obstruction 16. Urinary bladder Midline, suprapubic Usually not palpable When palpable- smooth, symmetrical, lower border not reached, Urge to micturate on palpation Dull on percussion 17. 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 18. 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 19. Dont forget Groin- LNE, hernia Male genitalia PR examination- for local pathology, prostate examination in males 20. Stigmata of CLD Muscle wasting Pallor, jaundice Clubbing Palmar erythema Dupuytrens contracture Spider nevi Gynecomastia Testicular atrophy Caput medusae Ascites 21. Supported by X-ray, US/CT, Endoscopy