Post on 16-Dec-2015
transcript
Winter Quarter 2010Winter Quarter 2010Adapted from previous years by Amanda Kocoloski, OMS IVAdapted from previous years by Amanda Kocoloski, OMS IV
Abdominal ExamAbdominal Exam
Agenda
HistoryAnatomyPhysicalPractice cases
2 gastrointestinal complaintsWork on incorporating GI into history and physical
exam skillsPractice documentation
History
Common Complaints:Abdominal painChange in appetiteDysphagia/Odynophagia
Difficult or painful swallowing
Nausea/VomitingJaundice
Change in bowel habitsMelena/Hematochezia
Dark tarry or red stools
HemorrhoidsAnal pruritis
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Enhancing the Exam
Empty bladderPatient comfort (pillows and draping)Arms at side or crossed over chestAsk the patient to point to any painful areas;
examine lastWarm hands and stethoscopeTicklish or nervous patients: slow movements,
distraction, use their hands
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Exam Order
InspectionAuscultation
Percussion or palpation can alter bowel sound frequency
Bonus Question: What is the medical term for “stomach growling”?Borborygmus
PercussionPalpation
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Abdominal Physical ExamInspection
ContourFlatScaphoidDistendedSymmetry
MovementPeristalticRespirationsAortic pulsation
SkinScars – cicatrixStriaeDiscolorationVenous patternsEdema
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Abdominal Physical ExamAuscultation
4 quadrants15-20 secondsBowel sounds
FrequencyPitch
Vascular SoundsRenalIliacFemoral
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Abdominal Physical ExamPercussion
Notes ElicitedTympanic
Predominant due to gas in GI tractHyperresonantDull
Organs, fluid and fecesFlat
Distension of abdomenFluid vs. Air
Outline OrgansLiver, spleen, and gastric bubble
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Abdominal Physical ExamPalpation
Start farthest from pain and move towards it4 abdominal quadrants
Light palpationDeep palpation
Peritoneal inflammationPain with coughing, gentle palpationInvoluntary rigidityRebound tenderness
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Abdominal Physical ExamPalpation - Left Upper Quadrant
Liver: left lobe Spleen Stomach Jejunum and proximal ileum Pancreas: body and tail Left kidney Left suprarenal gland Left colic (splenic) flexure Transverse colon: left half Descending colon: superior
part
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Liver: left lobe Spleen Stomach Jejunum and proximal ileum Pancreas: body and tail Left Kidney Left Suprarenal gland Left colic (splenic) flexure Transverse colon: left half Descending colon: superior
part
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Abdominal Physical ExamPalpation - Left Upper Quadrant
Abdominal Physical Exam Palpation - Right Upper Quadrant
Liver: right lobe Gallbladder Stomach: pylorus Duodenum: parts 1-3 Pancreas: head Right suprarenal gland Right kidney Right colic (hepatic) flexure Ascending colon: superior
part Transverse colon: right half
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Abdominal Physical Exam Palpation - Right Upper Quadrant
Liver: right lobe Gallbladder – Murphy’s sign Stomach: pylorus Duodenum: parts 1-3 Pancreas: head Right suprarenal gland Right kidney Right colic (hepatic) flexure Ascending colon: superior
part Transverse colon: right half
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Abdominal Physical ExamPalpation - Right Lower Quadrant
Cecum Vermiform appendix
McBurney’s point Rovsing’s sign Psoas sign Obturator sign
Most of ileum Ascending colon: inferior
part Right ovary Right uterine tube Right spermatic cord Uterus (if enlarged) Urinary bladder (if full)
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Abdominal Physical ExamPalpation - Right Lower Quadrant
Cecum Vermiform appendix
McBurney’s Point Rovsing’s sign Psoas sign Obturator sign
Most of ileum Ascending colon: inferior
part Right ovary Right uterine tube Right spermatic cord Uterus (if enlarged) Urinary bladder (if full)
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Abdominal Physical ExamPalpation - Left Lower Quadrant
Sigmoid colonDescending colon:
inferior partLeft ovaryLeft uterine tubeLeft ureter: abdominal
partLeft spermatic cord:
abdominal partUterus (if enlarged)Urinary bladder (if full)
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Abdominal Physical ExamPalpation - Left Lower Quadrant
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Sigmoid colonDescending colon:
inferior partLeft ovaryLeft uterine tubeLeft ureter: abdominal
partLeft spermatic cord:
abdominal partUterus (if enlarged)Urinary bladder (if full)
Abdominal Physical ExamPractice- 20 Minutes
• Inspection– Contour– Skin– Movement
• Auscultation– Bowel sounds– Vascular sounds
• Percussion– Abdomen for masses or fluid– Liver span– Spleen– Gastric bubble
• Palpate– General palpation– Liver– Gallbladder– Spleen– R and L kidneys– Abdominal aorta– Inguinal lymph nodes
• Special:– Murphy’s sign– McBurney’s point– Rovsing’s sign– Psoas sign– Obturator sign– Rebound tenderness– CVA tenderness
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