ABDOMINAL EXAMINATION POSITIONING qPatients hands remain on his/hers side qLegs, straight qHead resting on pillow – if neck is flexed, ABD muscles will tense and therefore harder to palpate ABD q. > lINSPECTION lAUSCULATION lPALPATION lPERCUSSION INSPECTION > INSPECTION lShape lSkin Abnormalities lMasses lScars (Previous op's - laproscopy) lSigns of Trauma lJaundice lCaput Medusae (portal H-T) lAscities (bulging flanks) lSpider Navi-Pregnant women lCushings (red-violet) l... > Hands + Mouth lClubbing lPalmer Erythmea lMouth ulceration lBreath (foeter ex ore) l... AUSCULTATION lUse stethoscope to listen to all areas lDetection of Bowel sounds (Peristalsis/Silent?? = Ileus) lIf no bowel sounds heard – continue to auscultate up to 3mins in the different areas to determine the absence of bowel sounds lAuscultate for BRUITS!!! - Swishing (pathological) sounds over the arteries (eg. Abdominal Aorta) l... > PALPATION lALWAYS ASK IF PAIN IS PRESENT BEFORE PALPATING!!! lFirstly: Superficial palpation lSecondly: Deep where no pain is present. (deep organs) lAssessing Muscle Tone: - Guarding = muscles contract when pressure is applied - Ridigity = inidicates peritoneal inflamation - Rebound = Releasing of pressure causing pain l....... > MURPHY'S SIGN lIndication: - pain in U.R.Quadrant lDetermines: - cholecystitis (inflam. of gall bladder) - Courvoisier's law – palpable gall bladder, yet painless - cholangitis (inflam. Of bile ducts) l... > METHOD lAsk patient to breathe out. lGently place your hand below the costal margin on the right side at the mid-clavicular line (location of the gallbladder). lInstruct to breathe in. lNormally, during inspiration, the abdominal contents are pushed downward as the diaphragm moves down. lIf the patient stops breathing in (as the gallbladder comes in contact with the examiner's fingers) the patient feels pain with a 'catch' in breath. lTest is positive. l... > BLUMBERG'S SIGN lDetermines: - peritonitis - appendicitis lALWAYS START OPP. SIDE TO WHERE THE PAIN IS !!!! lABD is compressed slowly and then rapidly released. lPain upon removal of pressure rather than application of pressure to the abdomen lPain present = positive. l... > McBURNEY'S POINT lFrom ASIS (anterior superior iliac spine) to the umbilicus. lDetermines: - location of appendix (varies) - deep tenderness @ point = acute appendicitis NOTE: McBURNEY'S PUNCH SIGN = Tenderness is presented when gently tapping the area of the back overlying the kidney producing pain in people with an infection around the kidney (perinephric abscess) or pyelonephritis. Carnett's sign lAbd. pain remains unchanged or increases when the muscles of the abdominal wall are tensed. lPositive = Abd. wall is the source of the pain (e.g. due to rectus sheath hematoma). lNegative = pain decreases when the patient is asked to lift the head; this points to an intra-abdominal cause of the pain l.. > Fluid wave test / Iceberg Sign lTest for ascites. lHave patient push their hands down on the midline of the abdomen. lThen you tap one flank, while feeling on the other flank for the tap. l> 1 litre of fluid allows the tap to be felt on the other side. l... > Spleen Only palpable if enlarged; splenomegaly – indicated by Castell's sign (bulge of U.LQuadrant). Patient on his/her Right Side & palpate from behind. Liver lPALPATE: - from R.iliac fossa up towards and under the last rib whilst the patient is breathing in deeply. lASSESSING: Regulatrities Smoothness Tenderness lPERCUSSION: - Outline of liver (norm: 8-12 cms) - In Mid-Clavicular Line from 2nd rib downwards lHollow ---> Dull ----> Hollow l... > HEPATO-JUGULAR REFLUX lPressing enlarged liver ---> Increases Jugular Filling ----> Hepatic congestion (R.Heart Failure) Head of Pancreas lDe Jardins Point: - MCL - 9th Costal Cartilage - Right Side lIndication: - Pancreatitis/Tumour @ head l... > THANK YOU FOR YOUR ATTENTION