Clinical Correlation in The Abdominal Examination

I've been posting about Abdominal Examination on last June, now I'll show you about some clinical correlation that we usually found in the abdominal examination. I hope this article will be worth,, ^___^

1. Abdominal Bruits. During Auscultation you listen to normal active bowel sound or some normal bruits (like bruits in the epigastric area from abdominal aorta, and the upper quadrants from renal arteries. But in some case you may listen to abnormal bruits. The abdominal bruits may be due to atherosclerotic lession, or masses that may be impinging on the abdominal aorta or renal arteries.
2. Rebound Tenderness. Begin palpating the abdomen very gently in all four quadrants. Look at the patient's face to see any signs of pain or discomfort. if there is abdominal tenderness, look for rebound tenderness by slowly pressing into the tender area then quickly releasing. Rebound tenderness may indicate peritonitis (inflammation of the peritoneum), which is classically seen in appendicitis.

Ascites Examination

ASCITES EXAMINATION 

 

1. Puddle sign :

·         Patient lays down in prone position with raised elbow and knee for 5 minutes

·         The diaphragm part of stethoscope is located on the medial of lower abdomen

·         The physician (examiner) listening to sound which is appear when fingers percuss the lateral abdomen

·         Keep conducting finger percussion while stethoscope is being moved away from the physician

·         If the edge of fluid gather is being reached, sound intensity will be louder

2. Shifting dullness

·         Percuss abdomen from the medial side to the lateral side, determine the edge of thympanic and dullness sound

·         Ask the patient to lay down in lateral position

·         Ascites sign will be positive if thympanic sound is changed to dullness in the same location in the abdomen.

3.Fluid Wave (undulation test) :

·         Put the examiner ‘s hand or patient ‘s hand on the middle of abdomen vertically

·         Compress the hand on the abdomen partitian

·         Percuss one side in the waist while the other hand palpates the waist in the opposite area.

·        Feel the fluid wave in the abdomen

Abdominal Examination

PHYSICAL EXAMINATION 

 

Inspection

 

1.      Asking the patient to lay down in supine position with light source in the backside of physician whether the light can illuminates feet to head, or whole abdomen

2.      The physician has a sit at the patient’s right side, and the physician’s head is higher than patient’s abdomen

3.      Examine skin and sclera

4.      Inspect or observe the abdomen contour, scar, venous congestion, peristaltic movement or mass in several minutes

5.      Observe abdomen distention, obesity, tympanitis, ascites, pregnancy, faeces, or neoplasm/ malignancy sign.

 

Auscultation

 

1.      Ask the patient to relax and breathe

2.       Put the stethoscope bell on the mid abdomen and Focus on listening to the sound in the abdomen

3.      Listen to the intestine noisy

4.      Determine the intestine noisy : normal or abnormal

5.      Locating the stethoscope on the fourth quadrants of abdomen

6.      Conducting auscultation

a.       Peristaltic sound can be heard underneath the umbilical, above the suprapubic, or in everywhere

b.      to hear thundering/tumultuous sound from hepatic rub in the upper and right side of umbilical

c.       to hear Abdominal aortic murmur approximately 5 cm below the xhypoideal processus or in epigastric area

7.      Auscultate Bruit sound of pancreatic carcinoma in the left side of epigastric and also sphlenic friction rub in the lateral abdomen

8.      If peristaltic sound can not be heard, keep auscultating for more minutes

9.      Note down the auscultation result

 

Palpation

 

1.      The physician’s hand must be warm or suitable with the room /body temperature

2.      Ask the patient to do flexion on the hip/pelvic and knee, and also breathe by open mouth

3.      Communicate with the patient during palpation

4.      Apply a gentle palpation :

a.       Placing the palmar surface with adduction position of fingers on the abdomen and palpate gently the abdomen partition into 1 cm depth

b.      The abdomen partition must be avoided from nail fingers

5.      Conducting the deeper palpation

6.      Put the fingers tip into abdomen partitian when conducting deeper palpation in about 4-5 cm pressure and try to find the structure under the abdomen

7.      Pay attention to the patients’ expression during palpation

8.      Palpate the abdomen in the left quadrant :

·         Goal : Finding palpable spleen, left kidney

·         Normal : No palpable mass

·         Perform bimanual palpation. The right hand is put into behind the left rib border on midaxillae line, and left hand is placed below the chest so that fingers bent over under the ribs

·         Ask the patient to take a deep breathe, and when patient inhale deeply, put the right hand deeply into the back of ribs border and raised it, and the left hand raised the back chest

·         Conduct this skill frequently conform to inspiration rhytm and placing right hand in a various position

9.      Palpate the abdomen in the right quadrant :

·         Goal : Finding palpable liver, right kidney

·         Put Right hand with adduction fingers into below border of rib which volar surface contacted to the surface of abdomen. Sensation tactile will be felt by tip fingers

·         Left hand supination is placed under the right chest

·         While inhale deeply, the right hand moving up and put it into at the end of inspiration and in concormity with inspiration, left hand elevating the chest

10.  The patient’s head should be elevated using pillow if pain manifest directly when abdomen palpation performed

11.  Conducting rebound palpation (bounced back pain) : compress the abdomen partition gently using finger tip and then withdraw the fingers suddenly. It is called Blumberg sign

12.  If the masses are found in abdomen; assess the location, size, consistency, rubberiness, mobility and pulsation

Percussion

 

1.      Percuss the fourth abdomen quadrant

2.      Percuss the liver upper border in the right midclavicule line, start from the middle of chest, percussion is done from upward into downward

3.      Resonance sound in the chest become dullness when the examiner percuss the liver and then dullness sound will be changed to thympanic when percussion is done on the large intestine

4.      Determine the location and the size of liver