Physical Examination of the Abdomen

Physical Examination of the Abdomen

Examiner:
Patient:
On the right side of the patient
Lying flat on bed
Arms on the sides
Abdomen exposed
Legs extended during inspection
Legs bent
quadrants-of-abdomen

physical-examination-abdomen


Examination of Abdomen:
1.Inspection
2.Palpation
3.Percussion
4.Auscultation
1.Inspection
General appearance
Writhing in pain (Renal or biliary colic)
Lying still in bed (Peritonitis)
Pale and sweating (Shock from pancreatitis or gastric perforation)
Respiratory rate
Inspect the abdomen
Contour
Striae
Ecchymosis
Grey Turner’s sign
Flank discoloration
Massive ecchymosis secondary to hemorrhagic pancreatitis
Cullen’s sign
Bluish discoloration of the umbilicus secondary to hemoperitoneum of any cause
Surgical scars
Other causes of Turner or Cullen’s sign:
Ruptured ectopic pregnancy
Severe trauma
Ruptured abdominal aortic aneurysm
Coagulopathy
Any condition with bleeding into the abdomen
Inspect for hernias
Ask patient to cough
Inspect the superficial veins
Evaluate the direction of drainage
Place tip of your index fingers on a vein that is oriented cephalad-caudad
Compress and slide index fingers apart for about 7-10 cm
Remove finger and observe the direction of flow
Vena caval obstruction: veins drains toward the head
Portal hypertension: dilated veins radiate from the umbilicus
2.Palpation

light-palpation-abdomen

deep-palpation-abdomen


Begin in an area farthest away from the pain
Use the flat part of the hand or pads of the finger
Lift hand from area to area
3.Percussion
Liver size
Shifting dullness (Ascites)
Evaluate all 4 quadrants
Percussion of the liver
Start on the Right midclavicular line in the mid chest
Percuss downwards
Chest: resonant
Liver: dull
Colon: tympanic
Percussion of the spleen
Spleen hidden within the rib cage against the Traube’s space
Traube’s space defined by:
Superiorly
6th rib
Laterally
anterior axillary line
Inferiorly
costal margin
Dullness in Traube’s space is observed in splenic enlargement
Rule out ascites
Examine for “shifting dullness”
Test for “fluid wave”
4.Auscultation
Bruits
Friction rubs (Vascular disease)
Loss of bowel sounds (Ileus)
High-pitched, hyperactive sounds (Intestinal obstruction)
Motion of air and liquid in the GIT
Use diaphragm of stethoscope over mid abdomen
Normal bowel sounds occur every 5-10 mins and have high-pitched sound
Absence of bowel sounds (Ileus )
Rushes of low-pitched rumbling sounds  (Hyperperistalsis)
“Succussion splash” (Observed in obstruction)
Listen for bruits
Evaluate each quadrant
May occur in stenosis of the renal artery or abdominal aorta
Listen for friction rubs
Right and upper left quadrant

Hepatic and splenic disorder


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