Post on 07-May-2015
description
Abdomen
History & Examination
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
Examination
Oral cavity
Abdomen Male genitalia
Anus/rectum
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
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
Abdomen- regions
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
Pre-examination
Comfortable room & couch Adequate light Patient lying supine Adequate exposure Examiner’s hand at the level of
patient’s abdomen
Examination- components
Inspection- see, don’t touch
Palpation- touch
Percussion- tap
Auscultation- use stethoscope
Inspection
Shape- scaphoid, normal, distended Umbilicus- shape, inverted/everted Movements- normal or restricted,
pulsation, visible peristalsis Striae or scars Prominent veins Genitalia & groin
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
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
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
Liver
RUQ Moves with respiration Tender or not? Edge- soft, firm, hard Surface- smooth, nodular Pulsatile in TR Confirm span by percussion
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
Urinary bladder
Midline, suprapubic Usually not palpable When palpable- smooth,
symmetrical, lower border not reached,
Urge to micturate on palpation Dull on percussion
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
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
Don’t forget
Groin- LNE, hernia
Male genitalia
PR examination- for local pathology, prostate examination in males
Stigmata of CLD Muscle wasting Pallor, jaundice Clubbing Palmar erythema Dupuytren’s contracture Spider nevi Gynecomastia Testicular atrophy Caput medusae Ascites
Supported by
X-ray, US/CT, Endoscopy