Abdominal Exam
Winter Quarter 2010
Adapted from previous years by Amanda Kocoloski, OMS IV
Agenda
History Anatomy Physical Practice cases
2 gastrointestinal complaints Work on incorporating GI into history and physical exam skills
Practice documentation
History
Common Complaints:
Abdominal pain Change in appetite
Dysphagia/Odynophagia
Difficult or painful swallowing
Change in bowel habits Melena/Hematochezia
Dark tarry or red stools
Nausea/Vomiting Jaundice
Hemorrhoids Anal pruritis
Anatomy
Regions (Anatomical) Quadrants (Clinical)
Surface Anatomy
Enhancing the Exam
Empty bladder Patient comfort (pillows and draping) Arms at side or crossed over chest Ask the patient to point to any painful areas; examine last Warm hands and stethoscope Ticklish or nervous patients: slow movements, distraction, use their hands
6
Exam Order
Inspection Auscultation
Percussion or palpation can alter bowel sound frequency Bonus Question: What is the medical term for stomach growling?
Borborygmus
Percussion Palpation
7
Abdominal Physical Exam
Inspection
Contour
Flat Scaphoid Distended Symmetry
Skin
Scars cicatrix Striae Discoloration Venous patterns Edema
Movement
Peristaltic Respirations Aortic pulsation
Abdominal Physical Exam
Auscultation
4 quadrants 15-20 seconds Bowel sounds
Frequency Pitch
Vascular Sounds
Renal Iliac Femoral
Abdominal Physical Exam
Percussion
Notes Elicited
Tympanic
Predominant due to gas in GI tract
Hyperresonant Dull
Organs, fluid and feces
Flat
Distension of abdomen
Fluid vs. Air
Outline Organs
Liver, spleen, and gastric bubble
10
Abdominal Physical Exam
Palpation
Start farthest from pain and move towards it 4 abdominal quadrants
Light palpation Deep palpation
Peritoneal inflammation
Pain with coughing, gentle palpation Involuntary rigidity Rebound tenderness
11
Abdominal Physical Exam
Palpation - Left Upper Quadrant
Liver: left lobe Spleen Stomach Jejunum and proximal ileum Pancreas: body and tail Left kidney Left suprarenal gland Left colic (splenic) flexure Transverse colon: left half Descending colon: superior part
12
Abdominal Physical Exam
Palpation - Left Upper Quadrant
Liver: left lobe Spleen Stomach Jejunum and proximal ileum Pancreas: body and tail Left Kidney Left Suprarenal gland Left colic (splenic) flexure Transverse colon: left half Descending colon: superior part
13
Abdominal Physical Exam
Palpation - Right Upper Quadrant
Liver: right lobe Gallbladder Stomach: pylorus Duodenum: parts 1-3 Pancreas: head Right suprarenal gland Right kidney Right colic (hepatic) flexure Ascending colon: superior part Transverse colon: right half
14
Abdominal Physical Exam
Palpation - Right Upper Quadrant
Liver: right lobe Gallbladder Murphys sign Stomach: pylorus Duodenum: parts 1-3 Pancreas: head Right suprarenal gland Right kidney Right colic (hepatic) flexure Ascending colon: superior part Transverse colon: right half
15
Abdominal Physical Exam
Palpation - Right Lower Quadrant
Cecum Vermiform appendix
McBurneys point Rovsings sign Psoas sign Obturator sign
Most of ileum Ascending colon: inferior part Right ovary Right uterine tube Right spermatic cord Uterus (if enlarged) Urinary bladder (if full)
16
Abdominal Physical Exam
Palpation - Right Lower Quadrant
Cecum Vermiform appendix
McBurneys Point Rovsings sign Psoas sign Obturator sign
Most of ileum Ascending colon: inferior part Right ovary Right uterine tube Right spermatic cord Uterus (if enlarged) Urinary bladder (if full)
17
[Link]
18
Abdominal Physical Exam
Palpation - Left Lower Quadrant
Sigmoid colon Descending colon: inferior part Left ovary Left uterine tube Left ureter: abdominal part Left spermatic cord: abdominal part Uterus (if enlarged) Urinary bladder (if full)
19
Abdominal Physical Exam
Palpation - Left Lower Quadrant
Sigmoid colon Descending colon: inferior part Left ovary Left uterine tube Left ureter: abdominal part Left spermatic cord: abdominal part Uterus (if enlarged) Urinary bladder (if full)
20
Extras
Abdominal Aorta Inguinal Lymph Nodes Costovertebral angle (CVA) tenderness
21
Abdominal Physical Exam
Practice- 20 Minutes
Inspection
Contour Skin Movement
Palpate
General palpation Liver Gallbladder Spleen R and L kidneys Abdominal aorta Inguinal lymph nodes Murphys sign McBurneys point Rovsings sign Psoas sign Obturator sign Rebound tenderness CVA tenderness
Auscultation
Bowel sounds Vascular sounds
Percussion
Abdomen for masses or fluid Liver span Spleen Gastric bubble
Special:
22
Practice Cases
45 minutes
Practice Documentation
15 minutes
Questions?
Have a great winter break!
