WinterQuarter2010AdaptedfrompreviousyearsbyAmandaKocoloski,OMSIV

AbdominalExam

Agenda

ó Historyó Anatomyó Physicaló Prac4cecases

ó 2gastrointes4nalcomplaintsó Workonincorpora4ngGIintohistoryandphysicalexamskills

ó Prac4cedocumenta4on

History

CommonComplaints:ó Abdominalpainó Changeinappe4teó Dysphagia/Odynophagia

ó Difficultorpainfulswallowing

ó Nausea/Vomi4ngó Jaundice

ó Changeinbowelhabitsó Melena/Hematochezia

ó Darktarryorredstools

ó Hemorrhoidsó Analpruri4s

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Anatomy

Regions(Anatomical) Quadrants(Clinical)

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SurfaceAnatomy

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EnhancingtheExam

ó Emptybladderó Pa4entcomfort(pillowsanddraping)ó Armsatsideorcrossedoverchestó Askthepa4enttopointtoanypainfulareas;examinelast

ó Warmhandsandstethoscopeó Ticklishornervouspa4ents:slowmovements,distrac4on,usetheirhands

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ExamOrder

ó Inspec4onó Ausculta4on

ó Percussionorpalpa4oncanalterbowelsoundfrequency

ó BonusQues4on:Whatisthemedicaltermfor“stomachgrowling”?ó Borborygmus

ó Percussionó Palpa4on

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AbdominalPhysicalExamInspec4on

ó Contouró Flató Scaphoidó Distendedó Symmetry

ó Movementó Peristal4có Respira4onsó Aor4cpulsa4on

ó Skinó Scars–cicatrixó Striaeó Discolora4onó Venouspa_ernsó Edema

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AbdominalPhysicalExamAusculta4on

ó 4quadrantsó 15-20secondsó Bowelsounds

ó Frequencyó Pitch

ó VascularSoundsó Renaló Iliacó Femoral

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AbdominalPhysicalExamPercussion

ó NotesElicitedó Tympanic

ó PredominantduetogasinGItractó Hyperresonantó Dull

ó Organs,fluidandfecesó Flat

ó Distensionofabdomenó Fluidvs.Air

ó OutlineOrgansó Liver,spleen,andgastricbubble

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AbdominalPhysicalExamPalpa4on

ó Startfarthestfrompainandmovetowardsitó 4abdominalquadrants

ó Lightpalpa4onó Deeppalpa4on

ó Peritonealinflamma4onó Painwithcoughing,gentlepalpa4onó Involuntaryrigidityó Reboundtenderness

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AbdominalPhysicalExamPalpa4on-LehUpperQuadrant

ó Liver:lehlobeó Spleenó Stomachó Jejunumandproximalileumó Pancreas:bodyandtailó Lehkidneyó Lehsuprarenalglandó Lehcolic(splenic)flexureó Transversecolon:lehhalfó Descendingcolon:superior

part

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ó Liver:lehlobeó Spleenó Stomachó Jejunumandproximalileumó Pancreas:bodyandtailó LehKidneyó LehSuprarenalglandó Lehcolic(splenic)flexureó Transversecolon:lehhalfó Descendingcolon:superior

part

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AbdominalPhysicalExamPalpa4on-LehUpperQuadrant

AbdominalPhysicalExamPalpa4on-RightUpperQuadrant

ó Liver:rightlobeó Gallbladderó Stomach:pylorusó Duodenum:parts1-3ó Pancreas:headó Rightsuprarenalglandó Rightkidneyó Rightcolic(hepa4c)flexureó Ascendingcolon:superior

partó Transversecolon:righthalf

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AbdominalPhysicalExamPalpa4on-RightUpperQuadrant

ó Liver:rightlobeó Gallbladder–Murphy’s

signó Stomach:pylorusó Duodenum:parts1-3ó Pancreas:headó Rightsuprarenalglandó Rightkidneyó Rightcolic(hepa4c)flexureó Ascendingcolon:superior

partó Transversecolon:righthalf

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AbdominalPhysicalExamPalpa4on-RightLowerQuadrant

ó Cecumó Vermiformappendix

ó McBurney’spointó Rovsing’ssignó Psoassignó Obturatorsign

ó Mostofileumó Ascendingcolon:inferior

partó Rightovaryó Rightuterinetubeó Rightsperma4ccordó Uterus(ifenlarged)ó Urinarybladder(iffull)

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AbdominalPhysicalExamPalpa4on-RightLowerQuadrant

ó Cecumó Vermiformappendix

ó McBurney’sPointó Rovsing’ssignó Psoassignó Obturatorsign

ó Mostofileumó Ascendingcolon:inferior

partó Rightovaryó Rightuterinetubeó Rightsperma4ccordó Uterus(ifenlarged)ó Urinarybladder(iffull)

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18Walgreens.com

AbdominalPhysicalExamPalpa4on-LehLowerQuadrant

ó Sigmoidcolonó Descendingcolon:inferiorpart

ó Lehovaryó Lehuterinetubeó Lehureter:abdominalpart

ó Lehsperma4ccord:abdominalpart

ó Uterus(ifenlarged)ó Urinarybladder(iffull)

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AbdominalPhysicalExamPalpa4on-LehLowerQuadrant

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ó Sigmoidcolonó Descendingcolon:inferiorpart

ó Lehovaryó Lehuterinetubeó Lehureter:abdominalpart

ó Lehsperma4ccord:abdominalpart

ó Uterus(ifenlarged)ó Urinarybladder(iffull)

Extrasó AbdominalAortaó InguinalLymphNodesó Costovertebralangle(CVA)tenderness

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AbdominalPhysicalExamPrac4ce-20Minutes

•  Inspec4on–  Contour–  Skin–  Movement

•  Ausculta4on–  Bowelsounds–  Vascularsounds

•  Percussion–  Abdomenformassesorfluid

–  Liverspan–  Spleen–  Gastricbubble

•  Palpate–  Generalpalpa4on–  Liver–  Gallbladder–  Spleen–  RandLkidneys–  Abdominalaorta–  Inguinallymphnodes

•  Special:–  Murphy’ssign–  McBurney’spoint–  Rovsing’ssign–  Psoassign–  Obturatorsign–  Reboundtenderness–  CVAtenderness

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