Abdomen

Question 1

Inspection

Answer 1

uncover abdomen and lie down on inspection table.
Inspect skin, umbilicus, is there any spontaneous movement : respiration, pulsation abdomen aorta, peristalsis intestines
Ask to breath in and out deeply. Any pain ?
Are respiratory movements increasing ? entire abdomen moving ?
Cough. Painful ? Observe abdominal movements. entire abdomen moving ?

Question 2

Abdomen quadrants and regions

Answer 2

From top right to bottom left (patient view)
quadrants : RUQ, LUQ, RLQ, LLQ
regions: right hypochondirum, epigastric, left hypochondrium, right lumbar, umbilical region, left lumbar, right iliac region, hypogastrium, left iliac region

Question 3

Auscultation

Answer 3

Auscultate with diaphragm the 4 quadrants around the umbilicus. Listen to peristaltic sounds. If hear sounds don’t listen to other parts.
Can try each quadrant 1min or each region 30sec. No abdominal peristalsis if no sound after this.

Question 4

Percussion

Answer 4

Costal arch: lower level liver
explorative percussion: percuss all regions systematically, S shape
Tympanic: hollow organ. certain amount of gaz. Variable tympanic in abdomen. Intestines and stomach.
dull: no air. liver, spleen (behind stomach, can be heard in axillary line), muscles, bones, full bladder
Ask if any pain while doing percussion. Look at face patient.
If pain or dullness(somewhere there shouldnt be). Inspect carefully, palpate.
Topographic: relative lung liver border (less resonant sound on midclavicular line) is upper border liver. absolute is lower border right lung (not important here)
Find lower border ( dull become tympany sound), not reliable. measure distance between upper and lower border: liver span (normal : 6-12cm)

Question 5

Palpation

Answer 5

First superficial palpation
Systematic S. If painful site was found: painful region last.
Assess tension, swelling, pain.
There shouldnt be strong abdominal resistance. Make sure patient relaxed: pillow under knees. If decrease: active muscular resistance. If not, pathology.
Deep palpation:
Systematic S. If painful site was found: painful region last.
Midline more resistance than lateral because of spine. Resistance by colon also possible.
Palpate liver: under costal arch, fingers parallel to costal arch, ask to breath in so liver pushed down. Liver cannot be palpated in most patients. Gall bladder should never be palpable

Question 6

Examination inguinal area

Answer 6

Pay attention to aspect of skin and if any swelling.
Palpate lymph nodes (horizontal and vertical group: inguinal fold). Swelling ? Pain ?
Rolling movements with fingers
Assess: location, shape, size, color, consistency, fluctuation, surface, mobility to skin and underlying layers
Palpate femoral artery