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    Physical Examination GI Track (INTERNATIONAL)

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    Annis
    The document provides guidance on performing a thorough abdominal physical examination, including inspection, auscultation, percussion, and palpation techniques to examine the liver, spleen, kidneys, aorta, and other abdominal organs, as well as maneuvers to identify areas of tenderness that could indicate conditions like appendicitis. Examiners are advised to carefully observe patients' responses during the exam and use warm hands and instruments to make the experience as comfortable as possible.

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    Physical Examination GI Track (INTERNATIONAL)

    Uploaded by

    Annis
    35 views59 pages
    The document provides guidance on performing a thorough abdominal physical examination, including inspection, auscultation, percussion, and palpation techniques to examine the liver, spleen, kidneys, aorta, and other abdominal organs, as well as maneuvers to identify areas of tenderness that could indicate conditions like appendicitis. Examiners are advised to carefully observe patients' responses during the exam and use warm hands and instruments to make the experience as comfortable as possible.

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    The document provides guidance on performing a thorough abdominal physical examination, including inspection, auscultation, percussion, and palpation techniques to examine the liver, spleen, kidneys, aorta, and other abdominal organs, as well as maneuvers to identify areas of tenderness that could indicate conditions like appendicitis. Examiners are advised to carefully observe patients' responses during the exam and use warm hands and instruments to make the experience as comfortable as possible.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    35 views59 pages

    Physical Examination GI Track (INTERNATIONAL)

    Uploaded by

    Annis
    The document provides guidance on performing a thorough abdominal physical examination, including inspection, auscultation, percussion, and palpation techniques to examine the liver, spleen, kidneys, aorta, and other abdominal organs, as well as maneuvers to identify areas of tenderness that could indicate conditions like appendicitis. Examiners are advised to carefully observe patients' responses during the exam and use warm hands and instruments to make the experience as comfortable as possible.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 59

    ABDOMINAL PHYSICAL

    EXAMINATION

    By : Dr Evelyn Angie M. Biomed


    INTRODUCTION
    • Introduce your self
    • Explain what you're going to do
    • Have the patient empty their bladder before examination
    • Have the patient lie in a comfortable, flat, supine position
    • Exposing only the area that are being examined
    • During the exam pay attention to their facial expression
    to assess for sign of discomfort
    • Use warm hand, warm stethoscope, and have short finger
    nails
    ABDOMINAL REGIO
    • When looking, listening, feeling and percussing imagine what
    organs live in the area that you are examining
    Physical Examination of the Abdomen

    Inspection

    Auscultatio
    Other Tests
    n

    Palpation Percussion
    INSPECTION
    General inspection
    • Flat or Scaphoid (Normally)
    • Distended/enlargement
    air, fluid, fat, mass, gravida
     Symmetric/ asymmetric
    • Scar/cicatrix
    • Striae/tatto
    • Cullen sign/turner sign
    SCAR / CICATRIX
    AUSCULTATION
    TARGET
    •Bowel sounds
    •Vascular sounds (bruits)
    •Fetal movement & heart sound

    It is performed before percussion or


    palpation
    Auscultation
    • Listening in one spot is usually sufficient (30-60”)
    • Cannot be said to be absent unless they are not heard for at
    least 3-5 minutes.
    • Normal : 5-34 peristaltic/min
    • Decrease :
    • Inflammatory processes of the serosa
    • After abdominal surgery
    • In response to narcotic analgesics or anesthesia

    • Hyperactive
    • Inflammation of the intestinal mucosa
    • intestinal obstruction
    Bruit location
    PERCUSSION
    Percussion (technique)
    • DIP joint of third finger
    (pleximeter) pressed
    firmly on the abdomen
    remainder of hand not
    touching the abdomen
    • Use the same technique
    during pulmonary
    examination
    • Two basic sound :
    tympanic vs dullness
    Determine the size of the liver

    • Measure the liver span by percussing hepatic


    dullness from above (lung) and below (bowel).
    A normal liver span is 6 to 12 cm in the
    midclavicular line
    Spleen percussion
    • Enlarged spleen produce a dull tone, in the left
    upper quadrant percussion but should then be
    verified by palpation.
    Shifting Dullness

    • Percuss from anterior abdomen laterally to outline areas of dullness


    • Patient rolled slightly toward the examined side; the dullness area will
    move/shift to medially  suggests ascites
    PALPATION
    General principle
    • First warm your hands
    • Any areas of pain or tenderness are
    reserved for evaluation at the end of
    the exam
    • Patient may be asked to rest feet on
    table with hips and knees flexed

    Technique :
    • Use palmar surface of fingers of one hand (greatest number of
    fingers) and a deep, firm, gentle maneuver to examine abdomen
    • Palpate deeply with finger pads (do not “dig in” with finger tips)
    • Either one or two handed
    technique is acceptable
    Type of abdominal pain

    • Arises from an organic lesion or


    functional disturbance
    Visceral • Dull, poorly localized
    pain • Sometime referred

    • Sharp, bright, and well localized


    • Involvement of parietal
    Somatic peritoneum, abdominal wall or
    pain skin itself
    REFFERED PAIN
    REFFERED PAIN
    Board-like rigidity

    • If abdominal wall is
    palpated as obviously
    tense, even as rigid as
    a board  board-like
    rigidity = defans
    muscular

    Caused by the spasm of abdominal muscle due to


    peritoneal irritation  peritonitis
    Liver palpation
    • Palpating hand is held
    steady while patient
    inhales  lifted and
    moved while the patient
    breathes out
    • Hepatomegaly : > 1cm
    below the costal margin
    • An exception : severe,
    chronic emphysema
    Always palpating from low down, so very large livers are
    not missed
    Alternate Method
    Liver palpation
    • Stand by the patient's
    chest.
    • "Hook" your fingers just
    below the costal margin
    and press firmly.
    • Is useful when the patient
    is obese or when the
    examiner is small
    compared to the patient
    Hepatojugular reflux sign

    • Pressing the liver will raise


    jugular vein pressure 
    becomes more bulged or
    distended,
    • Sign of the enlargement of
    liver passive congestion
    due to right heart failure.
    Spleen palpation
    • Support lower left rib cage
    with left hand while patient is
    supine and lift anteriorly on
    the rib cage.
    • Palpate upwards toward
    spleen with finger tips of right
    hand, starting below left
    costal margin.
    • Have the patient take a deep
    breath.
    • Seldom palpable in normal
    adults.
    • Normal palpable in COPD, and
    deep inspiratory
    Slight spleenomegaly
    Hackett’s classification of splenomegaly

    Class Findings on palpation


    0. Spleen not palpable even on deep
    inspiration.
    1. Spleen palpable below costal margin,
    usually on deep inspiration.
    2. Spleen palpable, but not beyond a
    horizontal line half way between the costal
    margin and umbilicus, measured in a line
    dropped vertically from the left nipple.
    3. Spleen palpable more than half way to
    umbilicus, but not below a line horizontally
    running through it.
    4. Palpable below umbilicus but not below a
    horizontal line half way between umbilicus
    and pubic symphysis.
    5. Extending lower than class 4.
    Kidney palpation
    • Place left hand posteriorly
    just below the right 12th rib.
    Lift upwards.
    • Palpate deeply with right
    hand on anterior abdominal
    wall.
    • Patient take a deep breath.
    • Feel lower pole of kidney and
    try to capture it between your
    hands.
    • Normal kidney rarely palpable
    BIMANUAL PALPATION OF THE KIDNEY
    Examination of Aorta

    • Press down deeply in the


    midline above the
    umbilicus.
    • The aortic pulsation is
    easily felt on most
    individuals  old, thin
    A well defined, pulsatile mass, > 3 cm across, suggests an aortic
    aneurysm.
    Murphy’s Sign

    • Examiner’s hand is at middle


    inferior border of liver.
    • Patient is asked to take deep
    inspiration.
    • If positive patient will
    experience pain and will stop
    short of full inspiration
    • Posible : hepatitis,
    subdiaphragmatic abscess,
    cholecystitis
    •
    McBurney’s Point
    • Localized tenderness
    below midpoint of line
    between right anterior
    iliac crest and umbilicus.
    • Heel strike, riding over
    bumps in road while
    driving, coughing, will
    produce pain.
    McBurney’s Pain

    Common Causes
    • Appendicitis
    • Incarcerated or strangulated
    hernia
    • Ovarian torsion (twisted
    Fallopian tube)
    • Pelvic inflammatory disease
    • Abdominal abscess
    • Diverticular disease
    • Meckel's diverticulum
    Costo-vertebral Tenderness

    • Use the heel of your closed fist


    to strike the patient firmly over
    the costovertebral angles.
    • Compare the left and right
    sides.
    • Commonly a clue for renal
    disease
    = Undulation
    Obturator Sign

    • Internally rotate right leg at the hip with the knee at


    90 degrees of flexion. Will produce pain if inflamed
    appendix is in pelvis.
    Iliopsoas Sign

    Patient can lay on side and extend leg at the hip or have
    patient lay on back and try to flex hip against the
    resistance of examiner’s hand on thigh. If patient has an
    inflamed retrocecal appendix, this will produce pain.
    Other maneuver

    • Rovsing’s Sign : patient will experience right lower quadrant


    pain (McBurney’s Point) when left lower quadrant is palpated
    • Rebound Tenderness
    • Warn the patient what you are about to do.
    • Press deeply on the abdomen with your hand.
    • After a moment, quickly release pressure  hurts more when you
    release
    CIRRHOSIS

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