medical

1. ABDOMINAL EXAMINATION
BY: Dr. ADEM A. (MD)
On NOV, 2021G.C.

2. ANATOMY
 Abdomen is the part of the trunk b/n the thorax & the
pelvis.
 Abdomen is a roughly cylindrical chamber.
 For descriptive purposes, the abdomen is often divided by
imaginary lines crossing at the umbilicus, into four
quadrants.
 Abdomen is also divided into nine sections

6. CON’T….
 Abdominal wall encloses the abdominal cavity.
 Abdominal viscera are either suspended in the peritoneal
cavity by mesenteries or are positioned b/n the cavity & th
musculoskeletal wall.
 Abdominal visceral organs include:-
• Major elements of GIT
• Spleen
• Components of the urinary system
• Suprarenal glands
• Major neurovascular structures

8. CON’T….
 Inspect the abdominal wall & pelvis in supine position.
 Abdominal wall is a continuous
 Visualize the landmarks of abdomen
 Anterolateral abdominal wall is bounded:-
1. Superiorly by the cartilages of the 7th to 10th ribs & the
xiphoid process
2. Inferiorly by the inguinal ligament & pelvic bones.

9. CON’T….
 When examining the abdomen, you may be able to feel
several normal structures.
- Lower margin of the liver
- Sigmoid colon
- Pulsations of the abdominal aorta
- Kidney is occasionally palpable

10. GIT SYSMTOMS
1. Nausea and vomiting
2. Abdominal pain
3. Diarrhea
4. Constipation
5. Dysphagea
6. GI bleeding
7. Abdominal distension
8. Indigestion/dyspepsia
9. Jaundice

11. 1. NAUSEA AND VOMITING
1.1 Nausea
An unpleasant sensation usually preceding
vomiting
1.2 Vomiting
 forceful oral expulsion of gastric content
 Retching: labored and simultaneous contraction of
abdominal and respiratory muscles
 Regurgitation: nonforceful expulsion of stomach
 Rumination:

12. TECHNIQUES OF
ABDOMINAL EXAMINATION

13. TECHNIQUES OF ABDOMINAL EXAMINATION
 PRECAUTION
• Approach the patient
• Stand on the right side of the pt
 Communicate with the pt
 Privacy of the patient
 Adequate light exposure
 Undress the patient
 Patient in supine anatomical position
 Make the patient comfortable

14. CON’T…
 If possible the patient should have an empty bladder.
• Distract the patient attention
 Follow the cardinal step of abdominal examination:-
1. INSPECTION
2. AUSCULTATION
3. PALPATION
4. PERCUSSION

15. INSPECTION
 Stand at the foot of the bed
 Then come to the right side of the pt & look for
 Scars
 Striae
 Dilated veins
 Rashes & lesions
 Peristalsis
 Pulsation
 Contour of the abdomen

16. INSPECTION
 Shape ( normal contour , distended , scaphoid)
Generalized distention: 5Fs
Localized distention : Symmetrical - SBO
Asymmetrical – gross enlargt of spleen, liver,
ovary
● Symmetry
● Mass/ Bulge/ Organomegally
● Movement w respiration
Absent or markedly ↓ed in generalized peritonitis
● Visible Peristalysis
① Intestinal obstruction ②In thin indiv’s

17.  Visible Pulsation
↑ed pulsation – Aortic aneurysm, liver
● Umblicus
Flat or inverted – Normal
Everted – Ascites, Cyst, mass, hernia
● Flank fullness
● Skin
. Striae/linea nigra – atrophica or gravidarum→ white or Pink
Cushing’s synd & excessive steroid tt→ Purple striae
. Scars
. Distended Veins – dilated vv of hepatic cirrhosis or IVC obstruction
● Hernial Sites

19. AUSCULTATION
 Warm the stethoscope before auscultation
 Auscultate for
1. Bowel sound
2. Bruit
3. Venus ham
4. Auscultate over enlarged organ &/or mass

20. AUSCULTATION
 Bowel sounds : clicks & gurgles, 5-34 per min
Causes of hypoactive bowel sounds
. Thick skin (obesity)
. Fluid accumulation
. Paralytic ileus
. Peritoneal inflammation
Causes of hyperactive bowel sounds
. Obstruction
● Bruits:
If bruit heard – either due to Stenosis or aneurysm.
.Over the aorta,
. each renal aa
. Each iliac aa & . The common femoral aa.

22. PALPATION
 Before you start palpation ask the pt whether he feel
abdominal pain or not
 If yes, ask the patient to point the site where he felt
maximum pain with a single finger if possible.
 Warm your hand before starting palpation.
 Hand & forearm on a horizontal plane
 Fingers together & flat on the abd surface
 Light , gentle, dipping motion
 Feel in all quadrants

23. Superficial Palpation : muscular
resistance, abd tenderness & some superf
masses.
→ Involuntary rigidity or Spasm of the abd mm(
guarding) –indicate Peritoneal inflammation

26. 2. DEEP PALPATION
 Is usually required to delineate abdominal masses.
 Feel for liver lower boarder & spleen.
 Bimanual examination for kidney.
 Ask the pt to breath in deep

28.  The Spleen
- If the spleen of an adult is palpable, it’s probably considerably larger than
normal.
- An enlarged spleen may be missed if the examiner starts too high in the abd
to feel in the lower edge.
◊ Mass in the left flank( attributes that favor an enlarged spleen over an enlarged Lt
kidney are:
 A notch on the medial border
 Extension beyond the midline
 Dullness to percussion
 The ability to get ur fingers deep to its medial & lower borders but not b/n the mass &
the costal marigin (i.e one cannot get above it)

31. LIVER
 Place both hands side by side flat on the abdomen.
 If resistance is encountered.
 Exert gentle pressure.
 Ask the pt to breathe in deeply

32.  The Liver:
- could be palpable in normal pts.
- The edge of an enlarged liver may be missed by starting palpn too high in
the abdomen.
- the edge of normal liver- soft, sharp, regular w smooth surface.
- If soft, smooth , tender- Hepatitis or venous congestion
- Very firm & regular – in obstructive jaundice , cirrhosis
- Hard, Irregular , painless( ss painful & ss nodular –in HCC
- Pulsating- in TR

36.  The Kidneys:
- Kidneys are not usu palpable(except in very thin ppl or kidney enlarg’t inc.,
hydronephrosis, Cysts, & tumors)
- Bimanual palpation
- Differentiate from spleen
- CVA tenderness: Pain w Pressure or w fist percussion in CVA suggests kidney
infecn.

37.  Abdominal Mass
- When an abd mass is palpable, spend time elliciting its features:
 Site
 Size & shape
 Surface edge & Consistency
 Mobility & attachments
 Is it bimanually palpable or pulsatile?

38. PERCUSSION
 To delineates the boundary of abdominal organs
To assess the amount & distribution of gas in the abdomen
 Tympanic notes
Identify possible masses
To measure the TLS along RMCL
 For PR evaluation

39. PERCUSSION
 The middle finger of the left hand is placed on the abdomen &
pressed firmly against it.
 The back of the distal interphalangeal joint is struck with the tip o
the middle finger of the right hand.
 The movement should be at the wrist rather than at the elbow.

40. PERCUSSION
 Light Percussion over the abd
 Liver Span: Normal liver spans 6-12cm in the MCL & 4-8cm in MSL.
-Four condns in w liver span changed falsely ’re: in perforated viscus
in emphysema
in effusion(rt) or consolidation
Gas in the colon.

42.  Spleen: dullness extending from Lt lower ribs into
the Lt hypochondrium & Lt lumbar region.

45. Shifting Dullness : Lie the pt supine & percuss
laterally from the midline until dullness is detected.
Then, keeping ur hand on the abd, ask the pt to roll
away from u, on the Lt side. Percuss again in this
new position; if the previously dullnote has now
become resonant then ascitic fluid is probably
present.

46.  Fluid Thrill: The pt laid on his back, place one hand flat over the lumbar region of
one side & get an assistant to put the side of his hand firmly in the midline of the abd,
& then flick or tap the opposite lumbar region. A fluid thrill or wave is felt as a definite &
unmistakable impulse by the detecting hand held flat in the lumbar region.

47.  DPR ; to asses for mass ,tenderness.

48.  PRACTICE AND PRACTICE
 THANK YOU.