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Abdominal Examination: Inspection, Palpation, Percussion, Auscultation

Learn how to perform a thorough abdominal examination, including inspection, palpation, percussion, and auscultation. This guide covers important techniques and findings for each step of the examination.

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Abdominal Examination: Inspection, Palpation, Percussion, Auscultation

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  1. بسم الله الرحمن الرحيم

  2. Abdominal ExaminationbyDr. Sally AbedLecturer Tropical Medicine

  3. ABDOMINAL EXAMINATION • INSPECTION • PALPATION • PERCUSSION • AUSCULTATION

  4. Quadrants (Clinical) 0 Anatomy Regions (Anatomical)

  5. ABDOMEN: Inspection

  6. Mid line inspection Inspection of sides INSPECTION 1-Subcostal angle 2-Epigastric pulsation 3-Divercation of recti 4-Umblicus 5-Suprapubic hair distribution 6-Hernial orifices 1-Contour of abdomen 2- Dilated veins 3- Skin 4-Scars 5- Movement with resp 6-Visible peristalisis

  7. MID LINE INSPECTION 1-Subcostal anglecauses of  2-Epigastric pulsationcauses 3-Divercation of recti?? 4-Umblicus - Site - Dilated veins - shape - Skin - Hernia - Discharge 5-Suprapubic hair distribution 6-Hernial orifices

  8. INSPECTION OF SIDES 1-Contour of abdomen 2- Collaterals (dilated veins) 3- Skin abdominal wall -Striae, scratch marks, sinus& fistula -Pigmentation, purpura 4-Scars Type, site, pigmentation, impulse on cough 5- Movement with respiration 6-Visible peristalsis

  9. Causes of abdominal enlargement ? Generalized: • Fluid (ascites) • Fat (obesity) • Flatus and faeces • Fluid in cyst (ovarian cyst) • Fetus (pregnancy) • Full bladder 2)Localized: • Hernias → size ↑ with cough • Masses in abdominal wall ( abscess & tumors) • Enlargement of intra-abdominal organs

  10. Collaterals (dilated veins)

  11. IVC obstruction

  12. PALPATION

  13. Ensure that your hands are warm • Stand on the patient’s right side • Help to position the patient • Ask whether the patient feels any pain before you start • Begin with superficial examination • Move in a systematic manner through the abdominal quadrants • Repeat palpation deeply.

  14. PALPATION Superficial Deep • Tenderness • Regidity • Masses 1- Liver 2- Spleen 3- Kidneys 4- Gall bladder 5- Colon

  15. Normally Palpable Structures

  16. PALPATION OF THE LIVER • Technique of palpation: 1- Upper border 2- Lower border 3- Liver span • Comment on: 1- Size 4- Consistency 2- Surface 5- Tenderness 3- Edge 6- Pulsation

  17. Liver Span

  18. Causes of hepatomegaly? 1)Infection: -Viral: Viral hepatitis ,IMN, CMV -Bacterial: Brucellosis ,T.B -Parasitic: Bilharziasis, Malaria ,Fasciola 2)Congestion: -Rt side ht failure -Tricusbed valve disease -Constrictive pericarditis -Budd chiari syndrome -Veno-occlusive disease

  19. 3)Infiltration - Amyloidosis - Leukemia - Lymphoma 6)Neoplastic: - HCC - Metastasis 7)Miscellaneous: -Collagen disease -Congenital cysts

  20. Causes of tender liver : 1- Infection 2- Congestion 3- Cholestasis 4- Infiltration 5- Malignancy

  21. PALPATION OF THE SPLEEN • Technique of palpation - Usual method - Bimanual examination - Two handed method - Hooking method - Dipping method

  22. 132-133: Palpation: Spleen Palpation: Spleen (correctly - position, breaths, palpating deepest full inspiration, 1 hand under L side, 1 feeling) Palpation: Spleen (if not palpable, R lateral decubitus)

  23. PALPATION OF SPLEEN Right lateral decubitus

  24. Causes of spenomegaly ? 1)Infection: 1-Viral: IMN, CMV 2-Bacterial: Septecemia ,Typhoid fever ,Brucellosis T.B ,Syphilis 3-Parasitic: Bilharziasis, Malaria, Leishmania 2)Congestion: (portal hypertension) 3)Infiltration -Amyloidosis -Sarcoidosis -Lipid storage disease -Leukemia- -Gaucher disease -Lymphoma

  25. 4)Blood disease: -Anemia 2-Polycythemia -Myeloproliferative disease 5)Neoplastic: -Hemangioma -Sarcoma -Metastasis 6)Miscellaneous: -Collagen disease -SLE -Rh. artheritis

  26. Grades of splenomegaly ? - Mild: Spleen just palpable under costal margin - Moderate: Spleen is palpable between costal margin and umbilicus - Huge : Spleen is palpable below the umbilicus

  27. Causes of huge splenomegaly ? • Bilharziasis • Chronic malaria • Kala azar • Chronic myloid leukemia • Hairy cell leukemia • Myelofibrosis, myelosclerosis • B- thalasemia • Amyloidosis • Gaucher, s disease

  28. Causes of tender spleen ? 1- Infection: - Septicemia - Infective endocardtis - Typhoid fever - Brucellosis - Acute malaria 3- Infarction: (perisplenitis, splenic rub) 4- Sickle cell anaemia 5-Causes of huge splenomealy

  29. PALPATION OF THE KIDNEY • Bimanual palpation • Causes of enlargement f the kidney? 1- Hydronephrosis 2- Pyonephrosis 3- Polycystic kidney 4- Tumour

  30. 135-136: Palpation of Kidneys R L Right kidney (take a deep breath, capture kidney, exhale, slowly release kidney Left kidney (take a deep breath, capture kidney, exhale, slowly release kidney)

  31. Percussion

  32. Ascites Abdominal organs PERCUSSION • Minimal ascites • Moderate ascites • Tense ascites • Liver • Spleen • Urinary bladder • Any palpable mass

  33. Percussion: Liver span The liver span is estimated by percussion. Remember that it is easier to hear the change from resonance to dullness – so proceed with percussion from areas of resonance to areas of dullness. Upper border: In the midclavicular line start percussing in the chest moving down towards the abdomen about ½ to 1 cm at a time. Note where the percussion notes change from resonate to dull. Lower border: In the midclavicular line begin percussion below the unbillicus and proceed upward until dullness is encounter. The distance between the two areas where dullness is first encountered is the liver span. Liver span is normally 6 to 12 cm in the midclavicular line.

  34. PUDDLE SIGN JAMA 1992;267:2645-2648

  35. Premature ascites:Dif:Ascites in cirrhotic patients before shrunken liverCauses:

  36. Ascites precox: Dif: Ascites before edema lower limb in cardiac patients Causes: 1-T.R 2-Pericardial effusion 3-Constrictive pericarditis

  37. PERCUSSION OF THE SPLEEN 1- Percussion of traube’s area 2- Castell’s method 3- Nixon’s method

  38. 1 2 1-Nixon's Method:Place the patient in the right lateral decubitus position. Initiate percussion half-way along the costal margin and percuss cephalad in a line perpendicular to the costal margin. Dullness of >8cm suggests splenomegaly. 2-Castell's Sign (in Traube's Space):in supine percuss in the lowest intercostal space in the left-anterior axillary line in full expiration and inspiration. Splenomegaly is suggested when the percussion is dull or becomes dull on inspiration.

  39. Nixon method

  40. Traubs area

  41. Traub’s area: Area of tympanetic resonance over fundus of the stomach Causes of dullness in traub’s area: 1-From above: Lt pleural eff., Pericardial eff. 2-From left : Splenomegally 3-From Right : Hepatomegally 4-From below: -Full stomach -Subpherinic abcess -Gastric tumour -Retroperitoneal neoplasm -Ascites -Complete situs inversus -Pregnancy

  42. AUSCULTATION

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