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ABDOMINAL EXAMINATION

ABDOMINAL EXAMINATION. Anatomy Regions Common presenting symptoms Examination Inspection Auscultation Percussion Palpation Liver and spleen 5. Specific maneuvers. Regions. Common presenting symptoms of Gastrointestinal disorders. Abdominal pain, acute or chronic

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ABDOMINAL EXAMINATION

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  1. ABDOMINAL EXAMINATION

  2. Anatomy • Regions • Common presenting symptoms • Examination • Inspection • Auscultation • Percussion • Palpation • Liver and spleen 5. Specific maneuvers

  3. Regions

  4. Common presenting symptoms of Gastrointestinal disorders • Abdominal pain, acute or chronic • Indigestion, nausea, vomiting including blood, loss of appetite, early satiety • Dysphagia / odynophagia • Diarrhea, constipation • Jaundice For each symptom, try to elicit all of its attributes SOCRATES (site, onset, character, radiation, associated factors, timing, exacerbating/relieving factors, severity)

  5. Example: Typical pain in Acute appendicitis • Site: poorly localized, periumbilical pain followed usually by RLQ pain • Onset: vague • Character: dull periumbilical pain, may be cramping • Radiation: periumbilical RLQ • Associated factors: anorexia, nausea/vomiting, low fever • Timing: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)

  6. Inspection • The skin: scar, striae, dilated vein, rashes and lesions • The umbilicus: contour, inflammation, bulges • The contour of the abdomen: flat, rounded, protuberant, scaphoid • Peristalsis • Pulsations: abdominal aorta in the epigastric region.

  7. SCAR

  8. PINK-PURPLE STRIAE OF CUSHING’S SYNDROME

  9. DILATED VEIN OF HEPATIC CIRRHOSIS

  10. RASHES

  11. UMBILICAL HERNIA IN NEWBORN

  12. Contour of the abdomen SCAPHOID (newborn with diaphragmatic hernia) PROTUBERANT

  13. AUSCULTATION • Before performing percussion and palpation because these maneuvers can alter the bowel sound • Bowel sounds (5-34/min) diarrhea, intestinal obstruction paralytic ileus, peritonitis • Bruits (renal artery stenosis)

  14. PERCUSSION • Percuss lightly in all four quadrant • Distribution of tympany and dullness.

  15. PALPATION • Light palpation: tenderness, muscular resistance, superficial organs and masses. • Deep palpation: delineate abdominal masses • Assessment for peritoneal inflammation: Cough  Palpation (guarding, rigidity)  rebound tenderness

  16. LIVER • Percussion • Palpation

  17. SPLEEN • Percussion: 2 techniques • Percuss the left lower anterior chest wall • Check splenic percussion sign • Palpation

  18. Time for test!

  19. A

  20. D

  21. C

  22. C

  23. “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”

  24. VN  English • Ănuốngbìnhthường, đicầubìnhthường • Khôngđaubụng, khôngnôn, khôngbuồnnôn • Bụngkhôngchướng, • Âmruộtbìnhthường, khôngnghetiếngthổiđộngmạch • Bụngmềm, khôngđau, khôngsờthấy u cục • Gan 1cm dướibờsườn, cao 8 cm trênđườngtrungđòn, láchkhônglớn • 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)

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