abdomen exam

Abdomen

History & Examination

Important history Dyspepsia- heartburn Dysphagia- difficulty swallowing Altered bowel habit- diarrhea/constipation Pain- colicky, stretch, radiation, referred Bleeding- UGI/LGI Jaundice Urinary symptoms- hematuria, dysuria,

frequency, urgency, hesitancy, retention Appetite Dietary history

Examination

Oral cavity

Abdomen Male genitalia

Anus/rectum

Oral cavity

Angular stomatitis, cheilitis Teeth- number, color, ridges, caries Gums- swelling, bleeding, pyorrhea Buccal mucosa- ulcer, pigmentation Tongue- size, color, papillae Palate, tonsils, pharynx

Abdomen- regions 4- vertical & horizontal planes thru

umbilicus- RUQ, RLQ, LUQ, LLQ 9- vertical planes thru 9th costal cartilage &

femoral artery; horizontal planes are subcostal & interiliac- R & L hypochondrium, lumbar, iliac and epigastrium, umbilical, hypogastrium

Abdomen- regions

Quadrants & organs RUQ- liver, GB, upper pole of R

kidney, hepatic flexure of colon LUQ- stomach, spleen, pancreas,

upper pole of L kidney, splenic flexure of colon

RLQ- lower pole of R kidney, appendix, terminal ileum, R colon, R ovary

LLQ- lower pole L kidney, L colon, L ovary

Pre-examination

Comfortable room & couch Adequate light Patient lying supine Adequate exposure Examiner’s hand at the level of

patient’s abdomen

Examination- components

Inspection- see, don’t touch

Palpation- touch

Percussion- tap

Auscultation- use stethoscope

Inspection

Shape- scaphoid, normal, distended Umbilicus- shape, inverted/everted Movements- normal or restricted,

pulsation, visible peristalsis Striae or scars Prominent veins Genitalia & groin

Palpation

Relaxed patient & abdominal wall Start from the point farthest from

possible area of involvement e.g. for liver start from LLQ & for spleen from RLQ

Palpate whole abdomen in an order

Special techniques

Deep palpation- in obese, muscular or poorly relaxed

Dipping- tense ascites Bimanual- for kidney & spleen Ballotable- kidney Shifting dullness & fluid thrill- for

ascitis

It helps Spleen L hypochondrium Grows towards RLQ Upper border not

reached Moves with

respiration Medial notch Not ballotable Dull on percussion

L kidney Renal angle posteriorly Grows towards LLQ Upper border

reachable Restricted mobility No notch Ballotable Colon overlying on

percussion

Liver

RUQ Moves with respiration Tender or not? Edge- soft, firm, hard Surface- smooth, nodular Pulsatile in TR Confirm span by percussion

Gall bladder

Underlies liver in RUQ Moves with respiration Usually not palpable Tender- Murphy’s sign- +ve in

acute cholecystitis Palpable GB- mucocoele, cancer,

CBD obstruction

Urinary bladder

Midline, suprapubic Usually not palpable When palpable- smooth,

symmetrical, lower border not reached,

Urge to micturate on palpation Dull on percussion

Percussion

Only light percussion required

Resonant note allover, except over liver where it is dull

Used to confirm liver or spleen or bladder enlargement & ascitis

Auscultation

Paraumbilical For bowel sounds or bruit Normal BS- intermittent gurgles

interspersed with tinkles Increased- intestinal obstruction Decreased- paralytic ileus Bruit- over aorta, iliac/renal arteries

Don’t forget

Groin- LNE, hernia

Male genitalia

PR examination- for local pathology, prostate examination in males

Stigmata of CLD Muscle wasting Pallor, jaundice Clubbing Palmar erythema Dupuytren’s contracture Spider nevi Gynecomastia Testicular atrophy Caput medusae Ascites

Supported by

X-ray, US/CT, Endoscopy