Abdominal Examination.pptx

medical

1. ABDOMINAL EXAMINATION BY: Dr. ADEM A . ( MD) On NOV , 2021G.C .

2. ANATOMY Abdomen is the part of the trunk b/n the thorax & the pelvis . Abdomen is a roughly cylindrical chamber. For descriptive purposes, the abdomen is often divided by imaginary lines crossing at the umbilicus, into four quadrants. Abdomen is also divided into nine sections

3. CON’T…. Abdominal wall encloses the abdominal cavity. Abdominal viscera are either suspended in the peritoneal cavity by mesenteries or are positioned b/n the cavity & the musculoskeletal wall. Abdominal visceral organs include :- Major elements of GIT Spleen Components of the urinary system Suprarenal glands Major neurovascular structures

4. CON’T …. Inspect the abdominal wall & pelvis in supine position. Abdominal wall is a continuous Visualize the landmarks of abdomen A nterolateral abdominal wall is bounded :- 1. Superiorly by the cartilages of the 7 th to 10th ribs & the xiphoid process 2 . Inferiorly by the inguinal ligament & pelvic bones .

5. CON’T…. When examining the abdomen , you may be able to feel several normal structures. - Lower margin of the liver - S igmoid colon - Pulsations of the abdominal aorta - Kidney is occasionally palpable

6. GIT sysmtoms Nausea and vomiting Abdominal pain Diarrhea Constipation Dysphagea GI bleeding Abdominal distension Indigestion/dyspepsia Jaundice

7. 1. Nausea and Vomiting 1.1 Nausea An unpleasant sensation usually preceding vomiting 1.2 Vomiting forceful oral expulsion of gastric content Retching : labored and simultaneous contraction of abdominal and respiratory muscles Regurgitation: nonforceful expulsion of stomach Rumination:

8. TECHNIQUES OF ABDOMINAL EXAMINATION

9. TECHNIQUES OF ABDOMINAL EXAMINATION PRECAUTION Approach the patient Stand on the right side of the pt Communicate with the pt Privacy of the patient Adequate light exposure Undress the patient Patient in supine anatomical position Make the patient comfortable

10. CON’T… If possible the patient should have an empty bladder. Distract the patient attention Follow the cardinal step of abdominal examination:- 1. INSPECTION 2. AUSCULTATION 3. PALPATION 4. PERCUSSION

11. INSPECTION Stand at the foot of the bed Then come to the right side of the pt & look for Scars Striae Dilated veins Rashes & lesions Peristalsis Pulsation Contour of the abdomen

12. Inspection Shape ( normal contour , distended , scaphoid ) Generalized distention: 5Fs Localized distention : Symmetrical - SBO Asymmetrical – gross enlargt of spleen, liver, ovary ● Symmetry ● Mass/ Bulge/ Organomegally ● Movement w respiration Absent or markedly ↓ ed in generalized peritonitis ● Visible Peristalysis ① Intestinal obstruction ②In thin indiv’s

13. Visible Pulsation ↑ ed pulsation – Aortic aneurysm, liver ● Umblicus Flat or inverted – Normal Everted – Ascites , Cyst, mass, hernia ● Flank fullness ● Skin . Striae / linea nigra – atrophica or gravidarum → white or Pink Cushing’s synd & excessive steroid tt → Purple striae . Scars . Distended Veins – dilated vv of hepatic cirrhosis or IVC obstruction ● Hernial Sites

14. auscultation Warm the stethoscope before auscultation Auscultate for Bowel sound Bruit Venus ham Auscultate over enlarged organ &/or mass

15. Auscultation Bowel sounds : clicks & gurgles, 5-34 per min Causes of hypoactive bowel sounds . Thick skin (obesity) . Fluid accumulation . Paralytic ileus . Peritoneal inflammation Causes of hyperactive bowel sounds . Obstruction ● Bruits: If bruit heard – either due to Stenosis or aneurysm. .Over the aorta, . each renal aa . Each iliac aa & . The common femoral aa .

16. PALPATION Before you start palpation ask the pt whether he feel abdominal pain or not If yes, ask the patient to point the site where he felt maximum pain with a single finger if possible. Warm your hand before starting palpation. Hand & forearm on a horizontal plane Fingers together & flat on the abd surface Light , gentle, dipping motion Feel in all quadrants

17. Superficial Palpation : muscular resistance, abd tenderness & some superf masses . → Involuntary rigidity or Spasm of the abd mm( guarding) –indicate Peritoneal inflammation

18. 2. Deep Palpation Is usually required to delineate abdominal masses. Feel for liver lower boarder & spleen. Bimanual examination for kidney. Ask the pt to breath in deep

19. The Spleen - If the spleen of an adult is palpable, it’s probably considerably larger than normal. - An enlarged spleen may be missed if the examiner starts too high in the abd to feel in the lower edge. ◊ Mass in the left flank( attributes that favor an enlarged spleen over an enlarged Lt kidney are: A notch on the medial border Extension beyond the midline Dullness to percussion The ability to get ur fingers deep to its medial & lower borders but not b/n the mass & the costal marigin ( i.e one cannot get above it)

20. LIVER Place both hands side by side flat on the abdomen. If resistance is encountered. Exert gentle pressure. Ask the pt to breathe in deeply

21. The Liver : - could be palpable in normal pts. - The edge of an enlarged liver may be missed by starting palpn too high in the abdomen. - the edge of normal liver- soft, sharp, regular w smooth surface. - If soft, smooth , tender- Hepatitis or venous congestion - Very firm & regular – in obstructive jaundice , cirrhosis - Hard, Irregular , painless( ss painful & ss nodular –in HCC - Pulsating- in TR

22. The Kidneys: - Kidneys are not usu palpable( except in very thin ppl or kidney enlarg’t inc., hydronephrosis , Cysts, & tumors) - Bimanual palpation - Differentiate from spleen - CVA tenderness: Pain w Pressure or w fist percussion in CVA suggests kidney infecn .

23. Abdominal Mass - When an abd mass is palpable, spend time elliciting its features: Site Size & shape Surface edge & Consistency Mobility & attachments Is it bimanually palpable or pulsatile?

24. PERCUSSION To delineates the boundary of abdominal organs To assess the amount & distribution of gas in the abdomen Tympanic notes Identify possible masses To m easure the TLS along RMCL For PR evaluation

25. PERCUSSION The middle finger of the left hand is placed on the abdomen & pressed firmly against it. The back of the distal interphalangeal joint is struck with the tip of the middle finger of the right hand. The movement should be at the wrist rather than at the elbow.

26. Percussion Light Percussion over the abd Liver Span: Normal liver spans 6-12cm in the MCL & 4-8cm in MSL. -Four condns in w liver span changed falsely ’re: in perforated viscus in emphysema in effusion( rt ) or consolidation Gas in the colon.

27. Spleen: dullness extending from Lt lower ribs into the Lt hypochondrium & Lt lumbar region.

28. Shifting Dullness : Lie the pt supine & percuss laterally from the midline until dullness is detected. Then, keeping ur hand on the abd , ask the pt to roll away from u, on the Lt side. Percuss again in this new position; if the previously dullnote has now become resonant then ascitic fluid is probably present.

29. Fluid Thrill: The pt laid on his back, place one hand flat over the lumbar region of one side & get an assistant to put the side of his hand firmly in the midline of the abd , & then flick or tap the opposite lumbar region. A fluid thrill or wave is felt as a definite & unmistakable impulse by the detecting hand held flat in the lumbar region.

30. DPR ; to asses for mass ,tenderness.

31. PRACTICE AND PRACTICE THANK YOU.