ABDOMINAL EXAMINATION Presentation[1].pptx

The abdominal examination consists of four basic components: inspection, palpation, percussion, and auscultation. It is important to begin with the general examination of the abdomen with the patient in a completely supine position. The presence of any of the following signs may indicate specific disorders.

1. Examination of abdomen PRESENTED BY: HAFIZA AIMAN HUMAIRA PRESENTATION Examination of Abdomen

2. Conventionally the abdomen is divided into 9 regions There are 4 dividing lines: midclavicular (2) - vertical subcostal - upper horizontal Trans-tubercular – lower horizontal Abdominal regions

3. Organs by Quadrants

4. BEFORE EXAMINATION Introduction Explain the procedure Gain permission to proceed Arms at side or crossed over chest Ask the patient to point to any painful areas; examine last Warm hands and stethoscope

5. Inspection Palpation Percussion Auscultation light and deep palpation, palpation of liver edge, spleen tip, kidneys, and aorta, percussion includes percussion of liver span. Abdominal examination

6. INSPECTION Shape and Distension Umbilicus Scars Movements Prominent veins Striae Bruises Pigmentation Visible peristalsis Standing at the foot of the table Lower yourself until the anterior abdominal wall ask the patient to breathe normally while you are inspect the abdomen.

7. ABDOMINAL PULSATION Aortic pulsation - visible in nervous, anemia. Transmitted pulsation - any mass lying over major artery produce pulsation. Rt ventricular pulsation seen in epigastric region DILATED VEIN

8. Assessing muscle tone with superficial palpation Gentle pressure applied to the abdominal wall should allow the examiner to depress the anterior wall of the abdomen as the muscles relax Contraction of the muscles underlying the hand as pressure is applied is called “guarding” and may indicate some underlying inflammation A rigid abdominal wall, resisting any attempt to push back the abdominal wall and usually not moving with respiration, indicates underlying peritoneal inflammation and is called “rigidity” A marked, acute exacerbation of pain on sudden release of pressure applied to the abdominal wall is called “rebound”

9. Deep palpation 1999 - 2010 Development Deep Using firm pressure to assess for deep swellings/abnormalities Deep palpation must be done with the palmar aspect of the fingers (get on the same level as the abdomen)

10. Methods of Palpation Classical method (single-handed palpation) Two-handed method Bimanual examination Dipping method

11. When palpating organs or masses feel for the edges Palpation of masses or organs may be assisted by assessment of mobility in relation to respiration liver descends towards right iliac fossa on inspiration spleen descend inferio-medially on inspiration towards the right iliac fossa the kidneys descend on inspiration Palpation

12. The liver moves inferiorly on inspiration Enlargement of the liver also occurs in an inferior direction In view of the direction of enlargement, palpation for the liver should commence well away from the costal margin in the right iliac area The thumb is extended to expose the lateral margin of the index finger The hand is positioned so that the lateral margin of the index finger is parallel with the costal margin How liver is palpated

13. the examiner's right hand is initially placed on the patient's abdomen in the right lower quadrant and parallel to the rectus muscle in the MCL. - Gently pressing in and up, ask the patient to take a deep breath Single-handed method Another method of palpating the liver uses the radial border of the index finger. In this method the anterior hand is placed flat on the anterior abdominal wall with fingers parallel to the costal margin

14. The long axis of the spleen lies along the the line of the 10th rib The spleen moves inferio- medially on inspiration Even on deep inspiration the normal spleen cannot be felt on palpation To be palpable the spleen must enlarge to at least twice normal size The patient is asked to take a deep breath in and pressure applied by the examiners hand to the abdominal wall If the spleen is not palpated, the examining hand is moved closer to the costal margin by about 1-2 cm Palpation of the spleen

15. They are retroperitoneal organs and deep bimanual palpation is required. To examine position the patient close to the edge of the bed Tuck the palmar surfaces of one hand into the patients flank Nestle the finger tips in the renal angle Palpation of the kidneys

16. Percussion Dull sounds : solid or fluid-filled structures Resonant sounds : structures containing air or gas It is important to distinguish kidney enlargement from splenomegaly on the left and hepatomegaly on the right Percussion of an enlarged liver or spleen will be dull whereas over the kidney it should be resonant due to the overlying bowel The kidneys can be “balloted” this a technique where by a structure that is not fixed can be patted between the examining fingers

17. General abdomen - should be resonant Organs Liver - dull Spleen - dull Kidneys - resonant Bladder - dull Ascites Shifting dullness Dullness peripheral Ovary Dullness centra l Percussion

18. Determines cause of abdominal distension, distinguishes between fluid and gas. There has to be a lot of fluid (ascites) present which can flow freely for the method to work With the patient lying on their back the highest point of fluid is detected by percussion and marked The patient rolls to an angle and is allowed to rest in this position for a short time to allow the free fluid to flow and establish a new upper level Percussion is repeated and fluid confirmed by detecting dullness “above” the previous level Detecting shifting dullness

19. FLUID THRILL Place the palm of your left hand against the left side of the abdomen Flick a finger against the right side of the abdomen Ask the patient to put the edge of a hand on the midline of the abdomen If a ripple is felt upon flicking we call it a fluid thrill = ascites

20. Thank You. For Your Attention OTHER EXAMINATION EXAMINATION OF GROIN HERNIA AND GENITALIA PER RECTAL EXAMINATION INSPECTION PALPATION