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ABDOMEN

ABDOMEN. PREMED H&P. INSPECTION. 1. Patient should lie down on examination table (Supine Position) 2. Drape a sheet over the pubic region 3. Abdomen should be exposed from above the xiphoid process (just below the breasts) to the symphysis pubis

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ABDOMEN

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  1. ABDOMEN PREMED H&P

  2. INSPECTION

  3. 1. Patient should lie down on examination table (Supine Position) • 2. Drape a sheet over the pubic region • 3. Abdomen should be exposed from above the xiphoid process (just below the breasts) to the symphysis pubis • 4. Patient arms should be at sides or folded across the chest

  4. Appearance of Abdomen: • A) Flat or Distended or Protrubent? • B) Symmetry • C) Surgical scars / Striae / Dilated Veins /Other skin abnormalities • D) Protrusions

  5. Umbilicus • Peristalsis – e.g. Intestinal Obstruction causes increased peristalsis • Pulsations - Aortic pulsation is visible in the epigastrium e.g. Aortic Aneurysm (Increased pulse) • Patient’s Movement

  6. Umbilical Hernia

  7. Enlarged Gall Bladder

  8. Ascites

  9. AUSCULTATION

  10. Performed before Percussion or Palpation • Above maneuvers can alter the frequency of bowel sounds (Palpating the abdomen may disturb the intestines) • Auscultate for normal bowel sounds – Place the stethoscope on the abdomen and listen for 15 to 20 seconds • 1) Presence of bowel sounds • 2) Listen carefully and assess for Frequency & Character

  11. Absent bowel sounds – e.g. Ileus – Intestinal obstruction, eg. Peritonitis • Hyperactive bowel sounds – e.g. Inflammation of mucosa due to infections causing diarrhea • Bruits – E.g. Renal artery stenosis due to hypertension • Bruits can be heart at aorta, iliac and femoral arteries as well

  12. Aorta Renal Artery Iliac Artery Femoral Artery

  13. PERCUSSION

  14. Technique that has to be mastered with practice • Percuss in all four quadrants to assess for the following sounds: • A) Tympany • B) Dullness • Tympany (drum-like sounds) occur with gas in the abdomen • Dullness occurs with solid structures or fluid in the abdomen

  15. Tympanic – Protrubent abdomen or intestinal obstruction • Dullness – e.g. Ascites, Feces, mass or *enlarged organ • During this procedure, make note of any pain that may indication inflammation or peritonitis

  16. Two major organs that are percussable: • A) Liver • B) Spleen • Area covering liver  Dull under percussion • **Size of liver must be determined by percussion • Splenomegaly  Enlargement will be dull under percussion (Assesed by Palpation)

  17. PALPATION

  18. LIGHT PALPATION

  19. DEEP PALPATION

  20. Liver Palpation

  21. Liver is located deep to the ribs 7- 11 • Start at the right upper quadrant • Place the left hand behind the patient • Place your right hand on the mid-clavicular line below the lower border of liver felt as dullness • Press gently in and up while you push posteriorly • Asking the patient to take deep breaths while pushing up and down can be easier to palpate the liver edges

  22. Hepatomegaly or Liver enlargement – e.g. Infections such as Malaria, Chronic abuse of alcohol

  23. SPLEEN PALPATION

  24. In a small percentage of adults, spleen is palpable • A palpable spleen can be felt by • Using the left hand to reach over posteriorly around the patient for support • Placing your right hand below the left costal margin.

  25. KIDNEY PALPATION

  26. What is the costovertebral angle? • Acute angle between the 12th rib and the vertebral column • To palpate the left kidney, place the right hand below the patient towards the costovertebral angle • Place the left hand gently in the left upper quandrant asking the patient to take deep breaths • Palpate firmly and deeply below the left costal margin • Kidney enlargement – e.g. Hydrophrosis, tumors, cysts

  27. Assess Kindey Tenderness – “Costovertebral angle tenderness” • To assess – Place ball of one hand on the costovertebral angle and strike with the ulnar surface of the other hand making a “fist”: • Kidney tenderness – e.g. Pyelonephritis or kidney infection

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