1 / 25

Abdominal Exam

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.

Télécharger la présentation

Abdominal Exam

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Abdominal Exam Winter Quarter 2010 Adapted from previous years by Amanda Kocoloski, OMS IV

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

  3. 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

  4. 0 Anatomy Regions (Anatomical) Quadrants (Clinical)

  5. 0 Surface Anatomy

  6. 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

  7. 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

  8. 0 Abdominal Physical ExamInspection • Contour • Flat • Scaphoid • Distended • Symmetry • Movement • Peristaltic • Respirations • Aortic pulsation • Skin • Scars – cicatrix • Striae • Discoloration • Venous patterns • Edema

  9. 0 Abdominal Physical ExamAuscultation • 4 quadrants • 15-20 seconds • Bowel sounds • Frequency • Pitch • Vascular Sounds • Renal • Iliac • Femoral

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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)

  17. 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)

  18. Walgreens.com

  19. 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)

  20. 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)

  21. Extras Abdominal Aorta Inguinal Lymph Nodes Costovertebral angle (CVA) tenderness

  22. 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

  23. Practice Cases • 45 minutes

  24. Practice Documentation • 15 minutes

  25. Questions? Have a great winter break!

More Related