Abdominal System Examination Subtitle Calibri Regular 14pt. Presenter/s Name Calibri Bold 14pt Title Calibri Regular 14pt Date 00/00/00

Transcription

1 Abdominal System Examination Subtitle Calibri Regular 14pt Presenter/s Name Calibri Bold 14pt Title Calibri Regular 14pt Date 00/00/00

2 Resources

3 Approaching the patient Be kind Be friendly Smile Introduce yourself clearly & simply Confirm Patient details and ask how the patient would like to be addressed Explain that you would like to write a few things down to help you remember the facts

4 Gloves should be warn only when. Examining any individual with exudative lesions or weeping dermatitis When handling blood-soiled or body fluid-soiled sheets or clothing

5 Preparation of the patient Have the patient empty their bladder before examination Have the patient lie in a comfortable, flat, supine position Have them keep their arms at their sides Before the exam, ask the patient to identify painful areas so that you can examine those areas last During the exam pay attention to their facial expression to assess for sign of discomfort

6 General Inspection General Inspection Observe for: Distention Jaundice wasting Scratch marks visible scars pulsations Stomata Wounds Drains Inspection Around The Bed Observe for any IV cannula insitu Fluids NG tube Nutritional supplements

7 Inspect the hands Inspect the Nails for Clubbing Koilonychia Leuconychia Inspect the hands for Palmar erythema Dupuytren s contractures Hepatic flap

8 Inspect the Arms Spider naevi (telangiectatic lesions) Bruising Wasting Scratch marks (chronic cholestasis)

9 Inspect the Face and Eyes Conjuctival pallor (anaemia) Sclera: jaundice, iritis Cornea: Kaiser Fleischer s rings (Wilson s disease) Xanthelasma (primary biliary cirrhosis) Parotid enlargement (alcohol)

10 Mouth Breath (fetor hepaticus) Lips Angular stomatitis Cheilitis Ulceration Peutz-Jeghers syndrome Tongue Atrophic glossitis Leicoplakia Furring Thrush Gums Gingivitis, bleeding Candida albicans Pigmentation

11 Inspect Neck and Chest Cervical lymphadenopathy Left supraclavicular fossa (Virchov s node) Gynaecomastia Loss of hair

12 Physical Examination of the Abdomen Inspection Palpation Percussion Auscultation

13 Inspection of Abdomen Distention Herniae Scars Striae Pulsations Peristalsis Distended veins Stomata Wounds/Dressing Drains Image from

14 Abdominal Quadrants: Clinical Exam Right Hypochondriac: liver, gallbladder, duodenum, right kidney and hepatic flexure of colon Right Lumbar: ascending colon, lower half Right Kidney Right iliac: Cecum, appendix, right ureter, (in case of female, right ovary & tube) Epigastric: Stomach, pancreas, liver, aorta, Umbilical: omentum, mesentary, transverse colon, Hypogastric: ileum, bladder Left hypochondriac: Stomach, spleen, pancreas, left kidney, Left Lumbar: small intestines, left kidney, descending colon Left Iliac: descending colon, sigmoid colon (in case of female, left ovary & tube) Image from

15 Palpation LIGHT PALPATION: First warm your hands by rubbing them together before placing them on the patient. Abdominal wall depressed approximately 1 cm Use pads of three fingers of one hand and a light, gentle, dipping maneuver to examine abdomen DEEP PALPATION: Entire palm, Either one- or two handed technique is acceptable Use palmar surface of fingers of one hand (greatest number of fingers) and a deep, firm, gentle maneuver to examine abdomen

16 Liver palpation Start in the RUQ,10 centimeters below the rib margin in the midclavicular line Place left hand posteriorly parallel to and supporting 11th & 12th ribs on right. Ask the patient to take a deep breath. You may feel the edge of the liver press against your fingers. Palpating hand is held steady while patient inhales Palpating hand is lifted and moved while the patient breathes out

17 Liver Enlargement Minor enlargement: Hepatitis Cirrhosis Metastatic dz All marked, moderate causes Moderate enlargement: Leukemia, lymphomas, etc. Fatty liver Hemochromatosis All marked causes Marked enlargement: Alcoholism RHF Carcinoma: metastases, or 1

18 Palpation of Spleen Support lower left rib cage with left hand while patient is supine and lift anteriorly on the rib cage. Palpate upwards toward spleen with finger tips of right hand, starting below left costal margin. Have the patient take a deep breath.

19 Splenomegaly DDx Sarcoidosis, amyloidosis Sjogren's Infectious: CMV IE, SBE Lyme disease Rheumatic fever Malaria Lymphoid: Leukaemias Lymphoma DIC

20 Palpation of Kidneys Right kidney Place left hand posteriorly just below the right 12th rib, above the right iliac crest and not as far in as the spine and paravertebral muscles As patient to take a deep breath Palpate deeply with right hand on anterior abdominal wall while flexing upwards with fingers of the left. (balloting) Lower pole can be felt in a few thin individuals or if enlarged Left Kidney Lean over patient, slide palm of left hand around and under into left renal angle Please right hand on the left flank and ballot the left kidney( The left kidney is not normally palpable

21 Palpation of Aorta Flat palm placed over the epigastrium to locate pulse Press down deeply in the midline above the umbilicus The aortic pulsation is easily felt on most individuals

22 Percussion DIP joint of third finger (pleximeter) pressed firmly on the abdomen remainder of hand not touching the abdomen LIVER: Start just below the right breast in a line with the middle of the clavicle. Percussion in this area should produce a relatively resonant note. Continue downward until the sound changes once again. At this point, you will have reached the inferior margin of the liver. Upper margin is noted by first dull percussion note Lower margin is noted by first tympanitic note

23 Auscultation Bowel sounds Vascular sounds (bruits) Friction Rubs It is performed before percussion or palpation Normal sounds are due to peristaltic activity. Are bowel sounds present? If present, are they frequent or sparse (i.e.quantity)? What is the nature of the sounds (i.e.quality)?