Surgical abdominal examination

material used during final exam preparation
hope benefit for all
*at own risk

1. SURGICAL ABDOMINAL EXAMINATION
1. Must examine in sitting unless you are a specialist
2. Any diagnosis
a. Etiology
b. Predisposing
c. Clinical feature (primary and 2
nd
complication)
d. Investigation
e. Management
3. Acute abdomen target PRO
a. Acute appendicitis
b. Acute pancreatitis
c. Cholangitis
4. Thing must know by dr saw in surgery
a. History
b. GPE
c. Abdomen
d. Mass examination
e. Ulcer examination
PER ABDOMEN EXAMINATION
Must 5
1. Consent
2. Privacy
3. Chaperon
4. Position
a. Best is supine (allow only 1 pillow)
b. Prop-up position (10 to 45 degree only)
c. Patient hand must be at side (not on chest/abdomen/behind head)
5. Exposure
a. Normal (nipple line till mid thigh but is Asian/cultural xiphi till pubic symphysis je)

2. Start!
INSPECTION
1. Duduk! Must eye level dengan patient abdomen and at right side
2. Look abdominal shape (imaginary line from costal to iliac creast)
a. Distended
b. Flat
c. Scaphoid (boat/sampan)
3. Stand up and go at bed side, comment on 5 thing
a. Umbilical
b. Symmetry
c. Flank
d. Mass
e. Move with respiration
4. Then duduk balik di side, comment other finding
a. Scar
b. Peristalsis
c. Hair
d. Pigmentation yada yada
e. JANGAN LUPA COUGH REFLEX! Look at tempat
i. Umbilical
ii. Periumbilical
iii. Scar
iv. epigastric
5. palpation, at side balik, duduk!, ada 3 jenis palpation
a. superficial
b. deep
c. organ

3. PALPATION
1. see tenderness
2. palm up/must horizontal arm, palpate temperature all 9 REGION (not 9 QUADRANT)
superficial palpation (look at face)
1. consistency
2. tenderness
a. if +, do rebound tenderness (verbal demonstration)
b. if -, do rigidity and guarding
deep palpation (look at face, kalau kau besar, guna 1 tangan, kalau kau kecik guna 2 tangan),
dipping method only in ascites to see liver
1. mass
a. kalau ada mass, pulsation kena check (transmitted or expansile)
organ palpation
LIVER
1. Explain to patient what your gonna do
2. Ask him to breath deeply and regularly
3. Start of rif, hand radial border parallel to costal (tunjuk sikit kau measure parallel di costal tu
then ke RIF), move cm by cm to liver
4. Jumpa lower border, minta patient hold by his finger
5. Then percuss along midclavicular at 2
nd
ICS till liver dullness, then measure and comment
enlarge ke tidak (showmanship cari sternal angle!)
6. If liver enlarge does not mean it enlarge, comment on
a. Surface (regular, irregular)
b. Edge (sharp, blunt)
c. Tenderness
SPLEEN
1. Explain to patient what your gonna do
2. Ask him to breath deeply and regularly
3. Use ur hand start at rif, finger parallel to rectus muscle
4. Move toward traube area (spleen)
5. Kalau spleen felt mean dah 2-3x enlarge
6. Kalau x palpable
a. Press down
b. Put patient in lateral
c. Percuss

4. KIDNEY
1. Explain to patient what your gonna do
2. Ask him to breath deeply and regularly
3. Ada 2 hand (watching hand – atas , ballot hand - bawah)
4. Renal angle (between erector spinae and 12
th
rib)
Differentiate between renal and spleen/renal and liver mass
PERCUSSION
1. All 9 region
2. Check shifting dullness
a. Positive shifting dullness
b. Fixed dullness (no negative dullness in this universe)
AUSCULTATION
1. All 9 region auscultate
2. Post op/laparotomy
a. Day 1, at terminal ileum, 2 cm right lateral of umbilicus
b. Day 2, over gastric area
c. Day 3 , Tanya dah pass flatus ke
3. Renal/aortic yada bruit
4. All must listen for 1 min