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Abdominal Exam

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. 0. History.

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Abdominal Exam

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  1. Abdominal Exam Winter Quarter 2010 Adapted from previous years by Amanda Kocoloski, OMS IV

  2. Agenda • History • Anatomy • Physical • Practice cases • 2 gastrointestinal complaints • Work on incorporating GI into history and physical exam skills • Practice documentation

  3. 0 History Common Complaints: Change in bowel habits Melena/Hematochezia Dark tarry or red stools Hemorrhoids Anal pruritis • Abdominal pain • Change in appetite • Dysphagia/Odynophagia • Difficult or painful swallowing • Nausea/Vomiting • Jaundice

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

  5. 0 Surface Anatomy

  6. 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

  7. 0 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

  8. 0 Abdominal Physical ExamInspection • Contour • Flat • Scaphoid • Distended • Symmetry • Movement • Peristaltic • Respirations • Aortic pulsation • Skin • Scars – cicatrix • Striae • Discoloration • Venous patterns • Edema

  9. 0 Abdominal Physical ExamAuscultation • 4 quadrants • 15-20 seconds • Bowel sounds • Frequency • Pitch • Vascular Sounds • Renal • Iliac • Femoral

  10. 0 Abdominal Physical ExamPercussion • 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

  11. 0 Abdominal Physical ExamPalpation • 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

  12. Abdominal Physical ExamPalpation - 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 ExamPalpation - 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

  14. 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

  15. Abdominal Physical Exam Palpation - Right Upper Quadrant • Liver: right lobe • Gallbladder – Murphy’s 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

  16. Abdominal Physical ExamPalpation - Right Lower Quadrant • Cecum • Vermiform appendix • McBurney’s point • Rovsing’s 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. Abdominal Physical ExamPalpation - Right Lower Quadrant • Cecum • Vermiform appendix • McBurney’s Point • Rovsing’s 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)

  18. Walgreens.com

  19. Abdominal Physical ExamPalpation - 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. Abdominal Physical ExamPalpation - 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)

  21. Extras Abdominal Aorta Inguinal Lymph Nodes Costovertebral angle (CVA) tenderness

  22. Abdominal Physical ExamPractice- 20 Minutes • Inspection • Contour • Skin • Movement • Auscultation • Bowel sounds • Vascular sounds • Percussion • Abdomen for masses or fluid • Liver span • Spleen • Gastric bubble • Palpate • General palpation • Liver • Gallbladder • Spleen • R and L kidneys • Abdominal aorta • Inguinal lymph nodes • Special: • Murphy’s sign • McBurney’s point • Rovsing’s sign • Psoas sign • Obturator sign • Rebound tenderness • CVA tenderness

  23. Practice Cases • 45 minutes

  24. Practice Documentation • 15 minutes

  25. Questions? Have a great winter break!

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