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Abdominal Exam. Winter Quarter 2010 Adapted from previous years by Amanda Kocoloski , OMS IV. Agenda. History Anatomy Physical Practice cases 2 gastrointestinal complaints Work on incorporating GI into history and physical exam skills Practice documentation. 0. History.

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abdominal exam

Abdominal Exam

Winter Quarter 2010

Adapted from previous years by Amanda Kocoloski, OMS IV

agenda
Agenda
  • History
  • Anatomy
  • Physical
  • Practice cases
    • 2 gastrointestinal complaints
    • Work on incorporating GI into history and physical exam skills
  • Practice documentation
history

0

History

Common Complaints:

Change in bowel habits

Melena/Hematochezia

Dark tarry or red stools

Hemorrhoids

Anal pruritis

  • Abdominal pain
  • Change in appetite
  • Dysphagia/Odynophagia
    • Difficult or painful swallowing
  • Nausea/Vomiting
  • Jaundice
anatomy

0

Anatomy

Regions (Anatomical)

Quadrants (Clinical)

enhancing the exam
Enhancing the Exam
  • Empty bladder
  • Patient comfort (pillows and draping)
  • Arms at side or crossed over chest
  • Ask the patient to point to any painful areas; examine last
  • Warm hands and stethoscope
  • Ticklish or nervous patients: slow movements, distraction, use their hands
exam order

0

Exam Order
  • Inspection
  • Auscultation
    • Percussion or palpation can alter bowel sound frequency
    • Bonus Question: What is the medical term for “stomach growling”?
      • Borborygmus
  • Percussion
  • Palpation
abdominal physical exam inspection

0

Abdominal Physical ExamInspection
  • Contour
    • Flat
    • Scaphoid
    • Distended
    • Symmetry
  • Movement
    • Peristaltic
    • Respirations
    • Aortic pulsation
  • Skin
    • Scars – cicatrix
    • Striae
    • Discoloration
    • Venous patterns
    • Edema
abdominal physical exam auscultation

0

Abdominal Physical ExamAuscultation
  • 4 quadrants
  • 15-20 seconds
  • Bowel sounds
    • Frequency
    • Pitch
  • Vascular Sounds
    • Renal
    • Iliac
    • Femoral
abdominal physical exam percussion

0

Abdominal Physical ExamPercussion
  • Notes Elicited
    • Tympanic
      • Predominant due to gas in GI tract
    • Hyperresonant
    • Dull
      • Organs, fluid and feces
    • Flat
  • Distension of abdomen
    • Fluid vs. Air
  • Outline Organs
    • Liver, spleen, and gastric bubble
abdominal physical exam palpation

0

Abdominal Physical ExamPalpation
  • Start farthest from pain and move towards it
  • 4 abdominal quadrants
    • Light palpation
    • Deep palpation
  • Peritoneal inflammation
    • Pain with coughing, gentle palpation
    • Involuntary rigidity
    • Rebound tenderness
abdominal physical exam palpation left upper quadrant
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
slide13

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
abdominal physical exam palpation right 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
abdominal physical exam palpation right upper quadrant1
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
abdominal physical exam palpation right lower quadrant
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)
abdominal physical exam palpation right lower quadrant1
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)
abdominal physical exam palpation left lower quadrant
Abdominal Physical ExamPalpation - Left Lower Quadrant
  • Sigmoid colon
  • Descending colon: inferior part
  • Left ovary
  • Left uterine tube
  • Left ureter: abdominal part
  • Left spermatic cord: abdominal part
  • Uterus (if enlarged)
  • Urinary bladder (if full)
abdominal physical exam palpation left lower quadrant1
Abdominal Physical ExamPalpation - Left Lower Quadrant
  • Sigmoid colon
  • Descending colon: inferior part
  • Left ovary
  • Left uterine tube
  • Left ureter: abdominal part
  • Left spermatic cord: abdominal part
  • Uterus (if enlarged)
  • Urinary bladder (if full)
extras
Extras

Abdominal Aorta

Inguinal Lymph Nodes

Costovertebral angle (CVA) tenderness

abdominal physical exam practice 20 minutes
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
practice cases
Practice Cases
  • 45 minutes
questions
Questions?

Have a great winter break!