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![Examination of the Abdomen Session Objectives: Describe relevant anatomy and](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-1.jpg)
Examination of the Abdomen
Session Objectives:
Describe relevant anatomy and physiology as it
pertains to the examination of the abdomen
Demonstrate the steps in examining the abdomen using illustrations and a SP
Review common abnormalities encountered on the Physical Examination of the abdomen
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![Examination of the Abdomen Introduction: The Medical History is an](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-2.jpg)
Examination of the Abdomen
Introduction:
The Medical History is an account of the
events in the pt’s life that have relevance to the mental/physical health of the pt. Accurate information is essential before undertaking the PE of the abdomen.
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![Examination of the Abdomen Pain is a common symptom of](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-3.jpg)
Examination of the Abdomen
Pain is a common symptom of diseases of
the abdomen It is important to assess different aspects of a pt’s abdominal pain so that a reasonable Differential Diagnosis can be formulated
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![Examination of the Abdomen Important aspects of abdominal pain: Location](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-4.jpg)
Examination of the Abdomen
Important aspects of abdominal pain:
Location and radiation of
pain
Character of pain (cramping, sharp, dull, burning, constant)
Timing of the pain
Exacerbating/alleviating features
Relationship to food intake
Relationship to defecation
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![Examination of the Abdomen Important related symptoms/signs in patients with](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-5.jpg)
Examination of the Abdomen
Important related symptoms/signs in patients with abdominal pain:
Fever/rigors/sweats
Nausea/vomiting
Weight
loss
Change in bowel habits
Evidence of GI blood loss (hematemesis, melena,hematochezia, occult loss)
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![Examination of the Abdomen Physical Examination: The PE of the](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-6.jpg)
Examination of the Abdomen
Physical Examination:
The PE of the abdomen must be
performed in an organized, systematic fashion in order to yield accurate and consistent results.Pt should be properly prepared. Pt should be lying supine, relaxed, draped, with hands at sides or crossed on chest. Quiet room/temp. Relaxed, confident examiner.
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![Examination of the Abdomen Physical Examinationof the Abdomen is conducted](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-7.jpg)
Examination of the Abdomen
Physical Examinationof the Abdomen is conducted in four
parts
Inspection/observation
Auscultation
Percussion
Palpation
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-8.jpg)
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-9.jpg)
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![Examination of the Abdomen For descriptive purposes, the abdomen is](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-10.jpg)
Examination of the Abdomen
For descriptive purposes, the abdomen is divided into
four quadrants
RUQ,LUQ,RLQ,LLQ
Epigastric,umbilical, periumbilical, suprapubic are terms also used by clinicians to describe symptoms and findings in those specific regions
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-11.jpg)
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-12.jpg)
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![Examination of the Abdomen Inspection/Observation (#40) Inspect the contour of](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-13.jpg)
Examination of the Abdomen
Inspection/Observation (#40)
Inspect the contour of the abdomen. It
may be flat, rounded, protuberant, or scaphoid
Are there any visible pulsations/masses?
Do the flanks bulge (ascites)?
Inspect skin (scars,striae,veins,rashes)
Inspect umbilicus
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-14.jpg)
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![Examination of the Abdomen Auscultation (#41) Useful in assessing bowel](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-15.jpg)
Examination of the Abdomen
Auscultation (#41)
Useful in assessing bowel motility and vascular
bruits
Note frequency/character of the bowel sounds (borborygmi) with stethoscope. Listen in one spot. Listen for bruits.
No particular bowel sound is diagnostic but rushes and high pitched tinkles suggest obstructed gut.
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-16.jpg)
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![Examination of the Abdomen Palpation (#43-#50) Palpate lightly then deeply](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-17.jpg)
Examination of the Abdomen
Palpation (#43-#50)
Palpate lightly then deeply in all four
quadrants
Differentiate between voluntary and involuntary guarding
If a mass is detected note its location, size, shape, consistency, tenderness, pulsation, and mobility
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-18.jpg)
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![Examination of the Abdomen Palpation (#43-#50) cont’d Assess peritoneal irritation](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-20.jpg)
Examination of the Abdomen
Palpation (#43-#50) cont’d
Assess peritoneal irritation and rebound tenderness
Palpate
liver, spleen, inguinal and femoral lymph nodes
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-21.jpg)
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-22.jpg)
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-24.jpg)
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![Examination of the Abdomen Percussion (#48) Percuss the liver in](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-25.jpg)
Examination of the Abdomen
Percussion (#48)
Percuss the liver in mid-clavicular line. Assess
size by percussing upper and lower borders. In COPD, normal sized livers are frequently palpated and lower border may be displaced downward.
In lean pts, spleen may be percussed
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-26.jpg)
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![Examination of the Abdomen Rectal examination and stool specimen for](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-27.jpg)
Examination of the Abdomen
Rectal examination and stool specimen for FOBT
Last step
of the physical examination. Stool sample retained for FOBT
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-28.jpg)
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-37.jpg)
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![Jaundice and Scleral Icterus](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-38.jpg)
Jaundice and Scleral Icterus
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-39.jpg)
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![Gynaecomastia or enlargement of breast tissue in men may occur either bilaterally or unilaterally.](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-40.jpg)
Gynaecomastia or enlargement of breast tissue in men may occur either
bilaterally or unilaterally.
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![Palmar Erythema is charactarized by a prominent rim of colour](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-41.jpg)
Palmar Erythema is charactarized by a prominent rim of colour beginning
on the hypothenar border of the hand but also in some individuals involving the thenar eminence and even the fingertips. Similar changes nay be observed on the soles of the feet.
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![Dupuytren's Contractures arise as a result of fibrous change in](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-42.jpg)
Dupuytren's Contractures arise as a result of fibrous change in the
palmar fascia which inserts into the flexor tendons, most commonly affecting the ring fingers
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![Parotid Hypertrophy contributes to the rounded appearance of the face;](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-43.jpg)
Parotid Hypertrophy contributes to the rounded appearance of the face; the
submandibular glands may also be enlarged.
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![Spider Naevi are found only in the distribution of the](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-44.jpg)
Spider Naevi are found only in the distribution of the superior
vena cava, most commonly on the face and the anterior chest wall. They comprise an enlarged central arteriole from which vessels radiate in a spoke-like manner.
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-45.jpg)
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-46.jpg)
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-50.jpg)
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![Thrombosed external hemorrhoids (long arrow) and perianal tags from "old" disease (short arrow).](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-51.jpg)
Thrombosed external hemorrhoids (long arrow) and perianal tags from "old" disease
(short arrow).
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![Prolapsed internal hemorrhoids, grade IV (long black arrow). The dentate](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-52.jpg)
Prolapsed internal hemorrhoids, grade IV (long black arrow). The dentate line
(short black arrow) is indicated, and a small polyp (white arrow) is visible.
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![](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-53.jpg)
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![Acute posterior fissure (arrow). Anterior and posterior fissures are most](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-54.jpg)
Acute posterior fissure (arrow). Anterior and posterior fissures are most common.
Fissures can often be identified by merely spreading the glutei but generally require anoscopy. When fissures are found laterally, syphilis, tuberculosis, occult abscesses, leukemic infiltrates, carcinoma, herpes, acquired immunodeficiency syndrome (AIDS) or inflammatory bowel disease should be considered as causes.
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![Anal tag (arrow). Anal tags should be removed or a](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-55.jpg)
Anal tag (arrow). Anal tags should be removed or a biopsy
should be obtained to confirm the etiology. Anoscopy may enable the physician to identify the cause or find other lesions.
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![Anal cancer (arrow). This anal cancer had been treated for](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-56.jpg)
Anal cancer (arrow). This anal cancer had been treated for three
months with steroid suppositories although the patient had never had a physical examination. Simple inspection of the external anal area allowed the physician to identify this aggressive tumor.
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![External site of perianal fistula. This patient presented with "just a little blood when I wipe."](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/244425/slide-57.jpg)
External site of perianal fistula. This patient presented with "just a
little blood when I wipe."