abdomen
DESCRIPTION
examinare clinicaTRANSCRIPT
![Page 1: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/1.jpg)
Introduction to the Practice of Medicine - II
Examination of the AbdomenTuesday, January 28, 2003
Michael J. Klamut, M.D.
![Page 2: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/2.jpg)
Examination of the AbdomenSession Objectives: Describe relevant anatomy and
physiology as it pertains to the examination of the abdomen
Demonstrate the steps in examining the abdomen using illustrations and a SP
Review common abnormalities encountered on the Physical Examination of the abdomen
![Page 3: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/3.jpg)
Examination of the Abdomen Introduction:
The Medical History is an account of the events in the pt’s life that have relevance to the mental/physical health of the pt. Accurate information is essential before undertaking the PE of the abdomen.
![Page 4: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/4.jpg)
Examination of the Abdomen Pain is a common symptom of
diseases of the abdomen It is important to assess different aspects of a pt’s abdominal pain so that a reasonable Differential Diagnosis can be formulated
![Page 5: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/5.jpg)
Examination of the Abdomen Important aspects of abdominal pain:
Location and radiation of pain Character of pain (cramping, sharp, dull,
burning, constant) Timing of the pain Exacerbating/alleviating features Relationship to food intake Relationship to defecation
![Page 6: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/6.jpg)
Examination of the Abdomen Important related symptoms/signs in
patients with abdominal pain: Fever/rigors/sweats Nausea/vomiting Weight loss Change in bowel habits Evidence of GI blood loss (hematemesis,
melena,hematochezia, occult loss)
![Page 7: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/7.jpg)
Examination of the Abdomen Physical Examination:
The PE of the abdomen must be performed in an organized, systematic fashion in order to yield accurate and consistent results.Pt should be properly prepared. Pt should be lying supine, relaxed, draped, with hands at sides or crossed on chest. Quiet room/temp. Relaxed, confident examiner.
![Page 8: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/8.jpg)
Examination of the Abdomen Physical Examinationof the
Abdomen is conducted in four parts
Inspection/observation Auscultation Percussion Palpation
![Page 9: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/9.jpg)
![Page 10: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/10.jpg)
![Page 11: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/11.jpg)
Examination of the Abdomen For descriptive purposes, the
abdomen is divided into four quadrants RUQ,LUQ,RLQ,LLQ
Epigastric,umbilical, periumbilical, suprapubic are terms also used by clinicians to describe symptoms and findings in those specific regions
![Page 12: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/12.jpg)
![Page 13: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/13.jpg)
![Page 14: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/14.jpg)
Examination of the Abdomen Inspection/Observation (#40)
Inspect the contour of the abdomen. It may be flat, rounded, protuberant, or scaphoid
Are there any visible pulsations/masses? Do the flanks bulge (ascites)? Inspect skin (scars,striae,veins,rashes) Inspect umbilicus
![Page 15: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/15.jpg)
![Page 16: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/16.jpg)
Examination of the Abdomen Auscultation (#41)
Useful in assessing bowel motility and vascular bruits
Note frequency/character of the bowel sounds (borborygmi) with stethoscope. Listen in one spot. Listen for bruits.
No particular bowel sound is diagnostic but rushes and high pitched tinkles suggest obstructed gut.
![Page 17: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/17.jpg)
![Page 18: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/18.jpg)
Examination of the Abdomen Palpation (#43-#50)
Palpate lightly then deeply in all four quadrants
Differentiate between voluntary and involuntary guarding
If a mass is detected note its location, size, shape, consistency, tenderness, pulsation, and mobility
![Page 19: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/19.jpg)
![Page 20: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/20.jpg)
![Page 21: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/21.jpg)
Examination of the Abdomen Palpation (#43-#50) cont’d
Assess peritoneal irritation and rebound tenderness
Palpate liver, spleen, inguinal and femoral lymph nodes
![Page 22: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/22.jpg)
![Page 23: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/23.jpg)
![Page 24: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/24.jpg)
![Page 25: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/25.jpg)
![Page 26: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/26.jpg)
Examination of the Abdomen Percussion (#48)
Percuss the liver in mid-clavicular line. Assess size by percussing upper and lower borders. In COPD, normal sized livers are frequently palpated and lower border may be displaced downward.
In lean pts, spleen may be percussed
![Page 27: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/27.jpg)
![Page 28: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/28.jpg)
Examination of the Abdomen Rectal examination and stool
specimen for FOBT
Last step of the physical examination. Stool sample retained for FOBT
![Page 29: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/29.jpg)
![Page 30: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/30.jpg)
![Page 31: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/31.jpg)
![Page 32: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/32.jpg)
![Page 33: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/33.jpg)
![Page 34: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/34.jpg)
![Page 35: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/35.jpg)
![Page 36: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/36.jpg)
![Page 37: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/37.jpg)
![Page 38: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/38.jpg)
![Page 39: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/39.jpg)
Jaundice and Scleral Icterus
![Page 40: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/40.jpg)
![Page 41: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/41.jpg)
Gynaecomastia or enlargement of breast tissue in men may occur either bilaterally or unilaterally.
![Page 42: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/42.jpg)
Palmar Erythema is charactarized by a prominent rim of colour beginning on the hypothenar border of the hand but also in some individuals involving the thenar eminence and even the fingertips. Similar changes nay be observed on the soles of the feet.
![Page 43: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/43.jpg)
Dupuytren's Contractures arise as a result of fibrous change in the palmar fascia which inserts into the flexor tendons, most commonly affecting the ring fingers
![Page 44: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/44.jpg)
Parotid Hypertrophy contributes to the rounded appearance of the face; the submandibular glands may also be enlarged.
![Page 45: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/45.jpg)
Spider Naevi are found only in the distribution of the superior vena cava, most commonly on the face and the anterior chest wall. They comprise an enlarged central arteriole from which vessels radiate in a spoke-like manner.
![Page 46: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/46.jpg)
![Page 47: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/47.jpg)
![Page 48: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/48.jpg)
![Page 49: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/49.jpg)
![Page 50: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/50.jpg)
![Page 51: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/51.jpg)
![Page 52: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/52.jpg)
Thrombosed external hemorrhoids (long arrow) and perianal tags from "old" disease (short arrow).
![Page 53: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/53.jpg)
Prolapsed internal hemorrhoids, grade IV (long black arrow). The dentate line (short black arrow) is indicated, and a small polyp (white arrow) is visible.
![Page 54: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/54.jpg)
Extensive perianal condyloma acuminata (arrow). This condition is generally caused by infection with human papillomavirus 6 or 11.
![Page 55: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/55.jpg)
Acute posterior fissure (arrow). Anterior and posterior fissures are most common. Fissures can often be identified by merely spreading the glutei but generally require anoscopy. When fissures are found laterally, syphilis, tuberculosis, occult abscesses, leukemic infiltrates, carcinoma, herpes, acquired immunodeficiency syndrome (AIDS) or inflammatory bowel disease should be considered as causes.
![Page 56: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/56.jpg)
Anal tag (arrow). Anal tags should be removed or a biopsy should be obtained to confirm the etiology. Anoscopy may enable the physician to identify the cause or find other lesions.
![Page 57: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/57.jpg)
Anal cancer (arrow). This anal cancer had been treated for three months with steroid suppositories although the patient had never had a physical examination. Simple inspection of the external anal area allowed the physician to identify this aggressive tumor.
![Page 58: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/58.jpg)
External site of perianal fistula. This patient presented with "just a little blood when I wipe."
![Page 59: Abdomen](https://reader036.vdocument.in/reader036/viewer/2022081520/5695d1641a28ab9b02965817/html5/thumbnails/59.jpg)
The wooden end of a cotton-tipped applicator was inserted 3 cm (see Figure 5), confirming a fistula. Blood on the end of a cotton-tipped applicator being withdrawn from a fistula that could easily have been missed.