Adobe Scan 13-Jan-2023
Adobe Scan 13-Jan-2023
Adobe Scan 13-Jan-2023
Examination of Abdomen
abdomen
Regions of the
There are two vertical planes and two horizontal planes
Left hypochondriac
Right hypochondriac Epigastric region
Stomach region
region - Stomach
- Liver Liver
- Liver (tip)
-Gallbladder Pancreas
- Right and left - Left kidney
- Right kidney - Spleen
and kidneys
Left lumbar region
Right Lumbar region Umbilical region -Small intestines
Liver(tip) Stomach - Descending colon
Small intestines Pancreas
- Left kidney
- Ascending colon -Small intestines
Transverse colon
Right kidney
Hypogastric region Left iliac region
Right iliac region - Small intestines
- Small intestines - Small intestines
- Sigmoid colon Descending colon
- Appendix
- Sigmoid colon
- Cecum and Bladder
ascending colon
Concepts of Clinical Examination in Surgery
Suprasternal
notch (T2/3)
Structures crossed by
transpyloricplane:
L1 vertebra
Transpyloric Pylorus
plane (L1) Pancreatic neck
Duodenojejunal flexure
Fundus of gall bladder
9th costal cartilage
Hila of kidneys
Origin of portal vein
Pubic Transverse mesocolon
symphysis 2nd part of duodenum
Superior mesenteric artery origin
Hilum of spleen
Termination of spinal cord
Transpyloric
plane
Duodenu
Transintercular
þlane
examinc
A. ETIQUETTE PRIOR TO HISTORY to their complaint and
nistory pertaining
them.
TAKING AND CLINICAL EXAMINATION
Take consent. erone
Introduce yourself to the patient have a
Ensure privacy and arrange to chapra
Inform the patient that you will ask about clinical available, if required.
Examination of Abdomen
C L I N I C A LH I S T O R Y
e) Drug history
d
with food e) Frequency constant in
Relation
pyloric obstruction
d)
e )C h a r a c t e r
Relation with food
1)Relievingfactors and aggravating factors g) Relief of pain after vomiting
2. F l a t u l e n tD y s p e p s i a
FAMILY HISTORY:
and Vomiting
Nausea a) Peptic Ulcer
; and onset
Character
a) b) Crohn's Disease
constan in
Frequency- pyloric obstruction
b) c)Ulcerative Colitis
c)Relation with food
d) Diverticulitis
of after vomiting
d) Relief pain e) Carcinoma
Haematemesis
and Malena
4. C.PHYSICAL EXAMINATION
5. Jaundice
Jaundice,
Build, Emaciation, Presence of anemia,
a) Due to neoplasia Examine the teeth, fauces, tonsils.
b) Calculous
Pulse, BP, Respiration, Temperature
c)Other
INSPECTION
Blood or mucus in stool- colonic diseases, 151
6. Bowel habits-
Constipation 1. Skin and subcutaneous tissue-
A. Ifsuperficial vein engorged-
7. Appetite
a) Position
8. Fever
b) Direction of flow
-
9. Loss of weight obstruction
10. Any lump or Swelling
Away from umbilicus portal
umbilicus-IVC obstruction
From below
-
a) Duration How to examine
on vein
b) Mode of Onset Two index fingers put closed together
Other Symptoms a/wlumps
d) Progression of swelling Vein emptied
e) Exact Site
a) Typhoid
b) Tuberculosis
c)Syphilis
d) Tonsillitis
in Surgery
Concepts of Clinical Examination
in a vein
How to determine blood flow direction
blood flow.
1 Place together to occlude
fingers
flow in distended abdominal wall va
Pattern of blood eins
Portal hyperlension
the other
Inferior vena caval obstruction
2 Move one finger away from
from umbilicus
away
Blood flows away from
now pYesent.
A segment Blobd flowssuperior vena cava) (toward superior venaumbilicus
of vein without blood is (toward cava
D. Contour of Abdomen Retraction or Distended performed in the same order. Maneuvers specific to
F.Swelling-
a) Condition of skin over swelling
in nine
b) Position, Size, Shape- Should be described
anatomical regions
-
process, i n whic
which
the patient oluntarily tightens The process is repeated until the
t h e
a b d o m i n a lm u s c l e s
to protect a deeper inflamed liver edge is palpated or the costal
minal muscles where the intra margin reached
an
involuntary process,
r
has progressed tocause rigidity A normal liver may be palpated
close to the liver costal margin
inal pathology muscles
Engaging the patient in
abdominal
abdondaminal muscles.
the fferentiate between voluntary An enlarged liver may be palpated
of sation mayhelp distal to the costal margin
as
the former disapp
guarding,
attention is diverted. Tenderness in The distance is measured in cms
patients abdomen may indicate
when from the costal margin
the nine regions ofthe
underneath.
anyof of the organs
n flammation
to proceed to palpation of the
step is
he
abdominal organs.
Palpation ofliver
Palpation of spleen
The spleen lies entirely
The liver lies predominantly under the ribs on the left side
under the ribs on the right side
although it does cross the midline.
The normal spleen is
approximately fst sized
The lowermost edge of the liver The long axis of the spleen
lies approximately parallel with lies aiong the line of the
the costal margin (the lower edge
10th rib
of the rib cage
asked to repeat
The patient is
and the
deep inspiration
process is repeated
Examination in Surgery under the patients The other
Concepts of Clinical One hand
in a.
hand with fingere
flank, fingers the renal angle placedbelow the s lat
(between posterlor lateral to the rectuscosta
and spine) musclemargin
costal margin
is asked to
The patientbreath in and
take a
deep the
pressure applied by
examiners hand to the
abdominal wall
not palpated,
If the spleen ishand is moved
the examlning
the costal margin by
closer to
about 1-2 cm Hands should be opposite one another
a) Local temperature
untl b) Tenderness
The process is repeated
or the and surface
the spleen is palpated c) Position, size, shape
costal margin reached
not be d) Margins
normal spleen will
A
palpated e) Consistency
An enlarged spleen my be f) Movement-
costal
palpated distal to the Movement with respiration
margin
.Movement ofswelling in all direction
The distance is measured in
cms from the costal margin Ballotability
g) Parietal or Intra-abdominal swelling - Rising test, Leg
raise test, Blow out from nose with mouth shut
Parietal Swelling are Prominent if muscles are taut
154 h) Swelling pulsatile or not- with two index fingers
Palpation of the kidneys
transmitted or expansile
The kidneys should not be palpated in every abdominal
examination, when indicated based on the clinical
only i) Any swelling at hernia site
history.
They are retroperitoneal PERCUSSION
organs and deep bimanual Percussion technique
palpation is required Take note of the technique
Use the tip of the finger
The blow is deliveredby
a sharp wrist movement
To examine position the
patient close to the
Strike the middle phalanx
edge of the bed 12th rrib firmly. Two-three taps only
Remove striking finger
11th rib immediately
Tuck the palmar surfaces
of one hand into the Kldney-
patients flank Liver dullness/span
Costovertebral
Nestle the finger tips in angle LIver span
the renal angle
Upper liver border is defined by
Posterlor view percussing down at Rt. 2nd IC space
in MCI., untl dullness is encountered.
Lower liver borderis defined by
percussing up at Rt. lliac fossa in
MCl., until dullness is encountered.
Normalliverspan is 10+/-2
Examination of Abdomen
Spleenpercussion
AUSCULTATION
last Lt. IC space & Lt.
ell'smethod percuss on
hod, pe resonant and dull if
Place the diaphragm anywhere around umbilicus.
normally
Aortic
h i t i n gd u l n eSsS
s.
out to Lt.
midline
the
r e a c h e d .
from
Percussd u l n e s s is
unti
patient liac
hank
ask the
and
thispoint
Mark you.
t o w a r d
rol
O
o repeat
Femoral
then
Sec.
for30
Wait
per uss again. 155
resonant
is
become
dull a r e a
Hthe
indication ofascites
detect
mild to
is
maneuver
is used
This
moderate ascites.
and
o v e r swelling
3 fingers thrill will be
thrill- place and after
Hydatid middle one
over
the
percussing
finger
felt by other2