7_examination of the abdomen

8/10/2019 7_Examination of the Abdomen

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History taking in abdominaldiseases


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History taking

Family history Colon cancer Gallstones


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History taking

Factors, habits and previousdiseases

Diet Drugs Alcohol Smoking Transfusion Iv. drug abuse Lifestyle


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History taking - summary Abdominal pain Dysphagia Nausea and vomiting Anorexia and unexpected weight loss Abdominal gas Abdominal distension Diarrhea Constipation Gastrointestinal bleeding Jaundice


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History taking

Abdominal pain Localisation Type

Severity Chronology Aggravating or relieving factors Associated symptoms Radiation of pain


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Diffuse abdominal pain

Peritonitis Intestinal obstruction

Irritable bowel syndrome Tense ascites


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Acute abdomen Peritonitis Appendicitis Bowel or gastric perforation Gallbladder perforation Intestinal obstruction (ileus) Mesenterial ischaemia Extrauterine pregnancy (ectopic pregnancy)

Acute necrotising pancreatitis Biliary colic Renal colic


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History taking

Other causes abdominal pain

Diabetic ketoacidosis Hyperthyroidism Acute intermittent porphyria Hypercalcemia, hyperkalemia Vasculitis Pneumonia Sickle cell crisis Herpes zoster


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Radiation of pain

Ulcer disease: to the back Biliary pain: to the back, right scapula,

right shoulder Pancreatic: band-like, to the back Kidney, ureter: to the genitalia, groin Splenic: left shoulder


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History taking

Substernal pain Cardiac painRadiation: leftType: pressing,

constrictingAggravating factors:

physical activity,stress

Relieving factors:nitrates

Associated symptoms:

dyspnoea, sweating

Esophageal painRadiation : backType:burning,

spasmodicAggravating factors:

body position, eating

Relieving factors:antacid

Associated symptoms:

dysphagia,regurgitation


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History taking

Dysphagia-difficulty in swallowing Where is the food hanging up?

oropharyngeal or esophageal Difficulty to swallow liquids?

Odynophagia- painful swallowing


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History taking

Weight loss Is it associated with anorexia? Chronology Severity (significant:> 5%

of body weight) Underlying diseases Causes:

general disorders: diabetes, hyperthyroidism,chr.infections,malignancy, medicationsbehavioral disorders: anorexia nervosa, depressionGI disorders: malignancy, malabsorption,

hepatic, biliary, pancreatic diseases


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History taking

Nausea and vomiting Organic, functional or psychogenic? connection with meals accompanied by weight loss

Content of the vomit Factors: taste, smell, color, pH Subtypes: acid : reflux disease, duodenal ulcer bile: bilio-pancreatic diseases

undigested food: obstruction of theupper GI

faeces (miserere): bowel obstruction(ileus)

blood: ie. ulcer, tumor, oes.varix


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History taking

Abdominal gas Belching, bloating (meteorism),

flatulence Causes

Aerophagia (habitual, poor dentition, inadequatechewing, rapid eating)

GI motor dysfunction or obstruction Malabsorption, maldigestion Bacterial overgrowth


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History taking

Bowel movement Factors: frequency, volume, fluidity, color,

associated sensations, change in bowel habits,stool calibre

Diarrhea> 300 g of stool/daymore than 3 loose or watery

stools/day Constipation two or less stools/week


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History taking

Bowel movement Stool alterations

Color - hypocholic, acholic- pleiochromic

- bloody Content - mucus

- blood

- fat - steatorrhea- undigested proteins -

creatorrhea


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History taking

Bowel movement Constipation

Chronic or recent onset Causes

Decreased fluid and/or food intake Functional (irritable bowel syndrome) Medications Hypothyroidism Fecal impaction Rectal or colon cancer Chronic debilitating disease


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History taking

GI bleeding Classification

Hematemesis - fresh blood- coffee ground

Melena Hematochezia - blood on the stool

- blood mixed with thestool

Occult bleeding


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History taking

Jaundice

Observe it in bright, natural light

First time you can observe on the sclerae


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History taking

Jaundice Important anamnestic factors Color of the skin: overproduction: lemon

obstructive: dark-yellow,

greenish Color of the stool: overproduction: dark, greenish

(pleiochromic)obstructive: hypocholic, acholic

Color of the urine: overproduction: cherry-redobstructive: dark, brown

Associated symptoms: anemia, pain, fever,hepatomegaly, splenomegaly, ascites


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Physical examination of theabdomen

1.Inspection2.Auscultation3.Percussion4. Palpation


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Position of the patient


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Physical examination Inspection

Configurations of the abdomenin the level or above or below the chest

apple-type : visceral obesity - cardiovascularrisk

pear-type : gluteal obesity Abdominal skin striae : white, livid (pink)

hernias veins : caput Medusae visible peristalsis visible pulsations scars

Physical examination


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Abdominal distension

Generalised Obesity

Pregnancy Ascites Bowel obstruction -

ileus Big ovarian cyst Peritonitis

Localised Hepatomegaly Splenomegaly Polycystic kidney Gastric distension Inflammatory mass Tumor Obstructed bladder Hernia


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Physical examination Auscultation

Bowel sounds above the umbilicus or in the RUQ normal: 5-35/min, clicks and gurgles altered: absent: paralytic ileus

hyperperistalsis: diarrhea,

mechanical bowel obstruction Bruits

arterial aortic, renal, iliac arteries

Friction rubs spleen, liver, peritonitis Succussion splash normal: above the

stomachpathologic: gastric or bowel obstruction


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Percussion

Meteorism Liver span midclavicular line: 6-12 cm

midsternal line: 4-8 cm Splenic dullness norm: in the midaxillary

line

pathological:dullness in the ant. axillary lineduring inspiration Liver or/and splenic dullness absent:

perforation


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Ascites shifting dullness


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Palpation Position Warm hands, short fingernails

Approach slowly, avoid quickmovements Exemine tender areas at last

Watch the patients face


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Palpation

1. Light palpationa. muscular resistance - guarding -

defense musculaireb. alterations in the abdominal wall


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Palpation

2. Deep palpationa. assessing abdominal massesb. assessing abdominal tenderness


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y

Palpation of the liver andspleen

Characteristics:1. size

2. surface3. edge4. consistency

5. tenderness(6. liver pulsation)


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Palpation of the gallbladder Hydrops vesicae felleaeCurvoisiers sign - painless enlargement of

the gallbladder due to cancer of the head ofthe pancreas

Murphys sign - RUQ pain aggravated byinspiration - acute cholecystitis


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Palpation of the aorta to the left of the midline normal: < 3-4 cm >6 cm: aortic aneurysm transmitted pulsations: pancreatic or

gastric tumor, pseudocyst of thepancreas


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Rectal digital examination Perianal diseases fistulas, masses Anal alterations hemorrhoids, fisssuras, masses Rectal alterations polyp, neoplasm, ulcer Prostate gland Douglass space

Stool on the glove

7_examination of the abdomen

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