ABDOMINAL EXAMINATION

AnatomyRegionsCommon presenting symptomsExaminationInspectionAuscultationPercussionPalpationLiver 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 CUSHINGS SYNDROME

DILATED VEIN OF HEPATIC CIRRHOSIS

RASHES

UMBILICAL HERNIA IN NEWBORN

Contour of the abdomenPROTUBERANTSCAPHOID(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 feltAbdomen is at. No bowel sounds heard. It is rm 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 Englishn ung bnh thng, i cu bnh thngKhng au bng, khng nn, khng bun nnBng khng chng, m rut bnh thng, khng nghe ting thi ng mchBng mm, khng au, khng s thy u ccGan 1cm di b sn, cao 8 cm trn ng trung n, lch khng ln

No anorexia (no change in dietary patterns), no diarrhea or constipation (no abnormalities in stool patterns or characteristics)No abdominal pain, no nausea or vomitingNo abdominal distensionBowel 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 RCMSpeen not felt (no spleenomegaly)

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