ABDOMINAL EXAMINATION

1. Anatomy2. Regions3. Common presenting symptoms4. Examination Inspection Auscultation Percussion Palpation Liver and spleen 5. Specific maneuvers

Regions

Common presenting symptoms of Gastrointestinal disordersAbdominal pain, acute or chronicIndigestion, nausea, vomiting including

blood, loss of appetite, early satietyDysphagia / odynophagiaDiarrhea, constipationJaundice

For each symptom, try to elicit all of its attributesSOCRATES (site, onset, character, radiation, associated factors, timing, exacerbating/relieving factors, severity)

Example: Typical pain in Acute appendicitisSite: poorly localized, periumbilical pain followed

usually by RLQ painOnset: vagueCharacter: dull periumbilical pain, may be crampingRadiation: periumbilical RLQAssociated factors: anorexia, nausea/vomiting,

low feverTiming: Periumbilical (4-6h), RLQ (depends on

intervention)Exacerbating/relieving factors: if subsides

temporarily, suspect perforation of the appendix, movement/cough.

Severity: periumbilical (mild but increasing), RUQ (steady/more severe)

InspectionThe skin: scar, striae, dilated vein, rashes

and lesionsThe umbilicus: contour, inflammation,

bulgesThe contour of the abdomen: flat,

rounded, protuberant, scaphoidPeristalsisPulsations: abdominal aorta in the

epigastric region.

SCAR

PINK-PURPLE STRIAE OF CUSHING’S SYNDROME

DILATED VEIN OF HEPATIC CIRRHOSIS

RASHES

UMBILICAL HERNIA IN NEWBORN

Contour of the abdomen

PROTUBERANT SCAPHOID(newborn with diaphragmatic hernia)

AUSCULTATIONBefore performing percussion and

palpation because these maneuvers can alter the bowel sound

Bowel sounds (5-34/min) diarrhea, intestinal obstruction paralytic ileus, peritonitisBruits (renal artery stenosis)

PERCUSSIONPercuss lightly in all four quadrantDistribution of tympany and dullness.

PALPATIONLight palpation: tenderness, muscular

resistance, superficial organs and masses.Deep palpation: delineate abdominal

massesAssessment for peritoneal inflammation:Cough Palpation (guarding, rigidity)

rebound tenderness

LIVERPercussionPalpation

SPLEENPercussion: 2 techniquesPercuss the left lower anterior chest wall Check splenic percussion signPalpation

Time for test!

A

D

C

C

“Abdomen is protuberant with active bowel sounds. It is soft and non-tender; no masses or hepatosplenomegaly. Liver span is 7 cm in the right midclavicular line; edge is smooth and palpable 1 cm below the right costal margin. Spleen not felt”

“Abdomen is flat. No bowel sounds heard. It is firm and boardlike, with increased tenderness, guarding, and rebound in the right midquadrant. Liver percusses to 7 cm in the midclavicular line; edge not felt. Spleen not felt”

VN English Ăn uống bình thường, đi cầu bình thường Không đau bụng, không nôn, không buồn nôn Bụng không chướng, Âm ruột bình thường, không nghe tiếng thổi động mạch Bụng mềm, không đau, không sờ thấy u cục Gan 1cm dưới bờ sườn, cao 8 cm trên đường trung đòn, lách

không lớn

No anorexia (no change in dietary patterns), no diarrhea or constipation (no abnormalities in stool patterns or characteristics)

No abdominal pain, no nausea or vomiting No abdominal distension Bowel sounds present (active bowel sounds), no bruits Abdomen soft and non-tender, no masses, Liver span is 8 cm in the right midclavicular line, edge is

palpable 1 cm below the RCM Speen not felt (no spleenomegaly)