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General Survey. Mental state: conscious, alert, cooperative Performance status: Easily exhausted Built: Average Facies: Normal Gait: Normal Hydration status: normal Nutrition: Average Pallor: absent Icterus: Absent. General Survey. Cyanosis: Absent Clubbing: Absent Edema: Absent
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General Survey Mental state: conscious, alert, cooperative Performance status: Easily exhausted Built: Average Facies: Normal Gait: Normal Hydration status: normal Nutrition: Average Pallor: absent Icterus: Absent
General Survey Cyanosis: Absent Clubbing: Absent Edema: Absent Neck veins: Normal Supraclavicular lymph nodes: not palpable Afebrile Pulse: 92/min BP: 130/80 mm of Hg RR: 28/min No obvious deformity or pigmentation
Local examination Inspection: Contour: fullness in epigastric, umbilical, right and left hypochondriac regions Moving with respiration Skin: normal Umbilicus: Slightly downwardly displaced, normal in shape, inverted No visible pulsations Respiration : Thoracoabdominal Hernial sites: No obvious swellings External Genitalia: No clinically obvious deformity.
Palpation: Temperature; Normal Superficial Tenderness: Minimal No muscle guard, rigidity Firm, globular, palpable lump spanning epigastric, umbilical, right and left hypochondriac regions, about 12 cm transversely and 10 cm vertically, with smooth surface, well defined rounded margins, not moving with respiration, not mobile, not fixed to skin or any other underlying structures, disappearing on rising test and not changing position on shifting test. No other palpable masses. liver, spleen kidneys not palpable.
Percussion: No evidence of free fluid Tympanic note all over abdomen Upper border of liver in 5th ICS Auscultation: Normal peristaltic sounds. No bruit No change in note on auscultopercussion External genitalia: Normal Hernial orifices: Normal