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# Abdominal Examinations: A Comprehensive Guide

## Introduction

Abdominal examinations are a crucial component of clinical assessment, helping healthcare professionals identify a wide range of conditions affecting the abdominal organs. The abdomen houses vital organs, including the liver, stomach, intestines, spleen, and kidneys. Abdominal pain, bloating, and changes in bowel habits can signify various pathologies, making a thorough examination essential.

This guide will cover the anatomy of the abdomen, the components of a complete abdominal examination, common findings, diagnostic significance, and considerations for special populations.

## Anatomy of the Abdomen

Understanding abdominal anatomy is critical for effective examination. The abdomen is divided into four quadrants:

1. **Right Upper Quadrant (RUQ)**:
- Contains the liver, gallbladder, duodenum, part of the pancreas, right kidney, and portions of the colon.

2. **Left Upper Quadrant (LUQ)**:
- Houses the stomach, spleen, left lobe of the liver, part of the pancreas, left kidney, and portions of the colon.

3. **Right Lower Quadrant (RLQ)**:
- Includes the appendix, cecum, part of the small intestine, right ovary (in females), and right ureter.

4. **Left Lower Quadrant (LLQ)**:
- Contains the sigmoid colon, part of the small intestine, left ovary (in females), and left ureter.

Understanding these quadrants assists in localizing pain and identifying potential sources of pathology.

## Components of a Complete Abdominal Examination

### 1. Patient History

A thorough patient history is foundational to any examination. Key aspects include:

- **Chief Complaint**: Document the main reason for the visit.
- **History of Present Illness**: Explore the onset, duration, character, and severity of symptoms (e.g., pain, nausea, changes in bowel habits).
- **Past Medical History**: Note any previous abdominal surgeries, chronic conditions (e.g., diabetes, liver disease), or gastrointestinal disorders.
- **Medications**: Assess current medications, including over-the-counter drugs and supplements.
- **Social History**: Gather information on lifestyle factors, including alcohol use, tobacco use, and diet.
- **Family History**: Identify any family history of gastrointestinal diseases.

### 2. Physical Examination

The physical examination consists of inspection, palpation, percussion, and auscultation. Each step provides vital information about the state of the abdominal organs.

#### Inspection

- **General Appearance**: Observe the patient's overall condition, including signs of distress or discomfort.
- **Abdominal Contour**: Note any distension, asymmetry, or unusual bulges.
- **Skin Changes**: Look for lesions, scars, striae, or signs of jaundice.
- **Visible Peristalsis**: Watch for abnormal movements that could indicate obstruction.

#### Auscultation

- **Bowel Sounds**: Listen for normal bowel sounds (usually every 5-15 seconds), hyperactive sounds (indicative of diarrh

1. Abdominal
Examination
Aparna
4th year Bsc Nursing

2. ARTICLES
Clean Tray
Measuring Tape
glouse
Linen

3. Doppler
Non Stress Test
Fetoscope

4. wheather the uterine avoid is
longitudinal:-aligned vertically,parallel to the mother
spine
Transverse:-the uterus is aligned
horizontally,acrossthe mothe abdomen
oblique:-the uterus is positioned diagonally neighther
longitudinal nor transvers
INSPECTION
Procedure

5. 2) contour of the uterus
Fundal notching: notch at the fundus of the uterus
Convex : the uterus has a curved ,Out ward
Flattened anterior wall: The anterior wall is flat or slightly concave
Cylindrical : Cylindrical or tubular shape
Spherical: rounded ,Spherical shape

6. 04
3.Undue enlargement of the uterus
4.skin changes:linea nigra/ striae gravida / scars
Striae gravida
Linea nigra

7. Scars

8. 5.Umbilicus
6.Bladder
7.Foetal movement
8.flank

9. PALPATION
* warm hands before palpation
* should not be done with uterine contractions
* conduct with most gentleness to avoid undue uterine
Irritability

10. Abdominal girth
* measure around abdomen at the level of umbilicus
Girth increases by about 2.5 cm per week beyond 30
week &term measures about 95 -100 cm

11. Height of the uterus :( symphysis fundal height)
The uterusis to be centralized if it is deviated .
The ulnar border of the left hand placed on the upper
most level of the fundus
Measure from symphysis pubis to top of fundus in cm.

12. Condition where SFH is incresed than normal Condition where SFH is lower than normal
*Mistaken dte of Lmp
*Twins
*Polyhydramnios
*Big baby
*Pelvic tumor
*Hydatidiform mole
*Concealed accidental hemorrhage
*Mistaken date of Lmp
*Scanty liquor amnii
*Fetal growth
*Retardation
*Intra uterine fetal death

13. OBSTETRIC GRIP ( Leopold maneuver )
______________
1) Fundal grip ( 1st Leopold )
2) lateral or umbilical grip (2 nd leopold)
3) pawlik 's grip ( Third Leopold)
4 ) pelvic grip (4 th leopold)

14. 1) fundal grip
______
The palpation is done facing the patient face . The whole of the fundal
area is palpated using both hands laid flat on it to find out which pole
of the fetus is lying in the fundus
a) broad ,soft &irregular mass suggestive of breech .
b) smooth ,hard & globular mass suggestive head.

15. Lateral or umbilical grip
__________
The palpation is done facing the patients face .The
hands are to be placed flat on either side of the
umbilicus to palpate one after the other
The side and front of the utreus to find out the
position of back ,limbs and the
Anterior shoulderg

16. 3) Pawlik 's grip
The examination is done facing toward the patient 's face
.The overstretched
thumb and four fingers of the righthand are placed over
the lower pole of the uterus keeping the ulnar border of
the palm on the upper border of the symphysis pubis .
When the fingers and the thumb are approximated the
presenting part is grasped distinely (not engaged ) and
mobility from side to side is tested . In transverse lie
pawlik's grip is empty.

17. 4) pelvic grip
___________
The Examination is done facing the patients feet . Four finger of
both the hands are placed on either side of the midline in the
lower pole of uterus and parallel to the inguinal ligament.
Fingers are pressed downwards and back wards in a manner of
approximation of finger tips to know the presentation
If the head the characteristics to note are
1)presentation
2) attitude
3)engagement

18. * precise presenting part : cephalic prominence is carefully palpated
and it relation to the limbs and back is noted.The cephalic
prominennce, being the sinciput, is placed on the same side towards
which limbs lie.
* Attitude: noting the relative postion of the sincipital and occipital
poles
*A -well flexed
*B-deflexed
*In well flexed head ,the sincipital pole is Placed at higher level in
deflexed state , both the poles remain at a same level.
Engagement - noting the presence or absence of the sincipital and
occipital poles or whether there is convergence or divergence of the
finger tips.

19. Thank
You.
For Your Attention