Thorax Abdomen Examination

8/18/2019 Thorax Abdomen Examination

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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

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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

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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'

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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

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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

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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

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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

Thorax Abdomen Examination

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