Abdomen exam
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This document provides guidance on performing an abdominal examination. It outlines important components of history to obtain including symptoms like dyspepsia, dysphagia, and altered bowel habits. The examination involves inspecting the abdomen and specific regions, palpating the abdomen and organs like the liver and spleen, performing percussion, and auscultating bowel sounds. Specific techniques for examining each organ are described along with signs to note. The full examination is supported by additional tests as needed.
Abdomen exam
- 2. Important history Dyspepsia- heartburn Dysphagia- difficulty swallowing Altered bowel habit- diarrhea/constipation Pain- colicky, stretch, radiation, referred Bleeding- UGI/LGI Jaundice Urinary symptoms- hematuria, dysuria, frequency, urgency, hesitancy, retention Appetite Dietary history
- 3. Examination Oral cavity Abdomen Male genitalia Anus/rectum
- 4. Oral cavity Angular stomatitis, cheilitis Teeth- number, color, ridges, caries Gums- swelling, bleeding, pyorrhea Buccal mucosa- ulcer, pigmentation Tongue- size, color, papillae Palate, tonsils, pharynx
- 5. Abdomen- regions 4- vertical & horizontal planes thru umbilicus- RUQ, RLQ, LUQ, LLQ 9- vertical planes thru 9th costal cartilage & femoral artery; horizontal planes are subcostal & interiliac- R & L hypochondrium, lumbar, iliac and epigastrium, umbilical, hypogastrium
- 7. Quadrants & organs RUQ- liver, GB, upper pole of R kidney, hepatic flexure of colon LUQ- stomach, spleen, pancreas, upper pole of L kidney, splenic flexure of colon RLQ- lower pole of R kidney, appendix, terminal ileum, R colon, R ovary LLQ- lower pole L kidney, L colon, L ovary
- 8. Pre-examination Comfortable room & couch Adequate light Patient lying supine Adequate exposure Examiners hand at the level of patients abdomen
- 9. Examination- components Inspection- see, dont touch Palpation- touch Percussion- tap Auscultation- use stethoscope
- 10. Inspection Shape- scaphoid, normal, distended Umbilicus- shape, inverted/everted Movements- normal or restricted, pulsation, visible peristalsis Striae or scars Prominent veins Genitalia & groin
- 11. Palpation Relaxed patient & abdominal wall Start from the point farthest from possible area of involvement e.g. for liver start from LLQ & for spleen from RLQ Palpate whole abdomen in an order
- 12. Special techniques Deep palpation- in obese, muscular or poorly relaxed Dipping- tense ascites Bimanual- for kidney & spleen Ballotable- kidney Shifting dullness & fluid thrill- for ascitis
- 13. It helps Spleen L hypochondrium Grows towards RLQ Upper border not reached Moves with respiration Medial notch Not ballotable Dull on percussion L kidney Renal angle posteriorly Grows towards LLQ Upper border reachable Restricted mobility No notch Ballotable Colon overlying on percussion
- 14. Liver RUQ Moves with respiration Tender or not? Edge- soft, firm, hard Surface- smooth, nodular Pulsatile in TR Confirm span by percussion
- 15. Gall bladder Underlies liver in RUQ Moves with respiration Usually not palpable Tender- Murphys sign- +ve in acute cholecystitis Palpable GB- mucocoele, cancer, CBD obstruction
- 16. Urinary bladder Midline, suprapubic Usually not palpable When palpable- smooth, symmetrical, lower border not reached, Urge to micturate on palpation Dull on percussion
- 17. Percussion Only light percussion required Resonant note allover, except over liver where it is dull Used to confirm liver or spleen or bladder enlargement & ascitis
- 18. Auscultation Paraumbilical For bowel sounds or bruit Normal BS- intermittent gurgles interspersed with tinkles Increased- intestinal obstruction Decreased- paralytic ileus Bruit- over aorta, iliac/renal arteries
- 19. Dont forget Groin- LNE, hernia Male genitalia PR examination- for local pathology, prostate examination in males
- 20. Stigmata of CLD Muscle wasting Pallor, jaundice Clubbing Palmar erythema Dupuytrens contracture Spider nevi Gynecomastia Testicular atrophy Caput medusae Ascites
- 21. Supported by X-ray, US/CT, Endoscopy