34. Palpation of masses the masses of abdomen may be caused by enlarged organ ectopic organ cyst carcinoma inflammatory tissues enlarged lymphnode
4(1)Normal masses of abdomen tendon of abdominal rectus lumber vertebral body sacral promontory sigmoid colon transverse colon cecum
5(2).Abnormal mass of abdomen when you palpate the mass of abdomen you should describe the location size contour consistency tenderness pulsation mobility
6The location of mass The mass usually originate from located organ, where you find a mass where the organ has lesion. If the location of mass is variable, the mass may originate from omentum, mesentery, or with stalk.
7big mass without intestinal obstruction, the mass originate from mesentery peritoneum omentum postperitoneum
8The size of mass The mass should be measured with a ruler to see how big it is, but sometimes the measurement is difficult, such as deep mass, small mass so you can estimate the size of mass, comparing with something like peanut, bean, egg, fist, baby`s head and so on.
9Big mass usually indicate cyst such as ovarian cyst, hepatic cyst or polycystic kidney. Intestinal tumor usually accompanied with intestinal obstruction. Mass with variable size indicates spasm of intestinal segment.
10The contour of mass ※ the outline of mass is clear or not ※ the surface is smooth or not ※ the margin is sharp or blunt ※ round and smooth mass indicate a cyst
11※ Irregular, nodular, hard mass indicate malignant tumor ※ A soft cystic mass in right hypochondrial region indicate distended gallbladder ※ A mass with notch in left upper quadrant indicate splenomegaly
12The consistency of mass ※ soft mass cyst, abscess ※ middle hard inflammatory mass ※ hard tumor the tenderness of mass ※ severe tenderness inflammatory mass ※ light tenderness tumor
13The pulsation of mass ※ abdominal aneurysm or a mass next to the aorta ※ enlargement of liver with pulsation tricuspid valve incompetence
14The mobility of mass ※ a mass move with respiration it maybe from liver, spleen, stomach, kidney, gallbladder or transverse colon ※ a mass can be moved with hand it may be from stomach, intestine or mesentery
15※ A mass can be moved easily and widely it may be from a tumor with a stalk wandering kidney wandering spleen ※ A mass can not be moved it may be from postperitoneal or inflammatory mass
165. Fluid wave thrill with the patient in supine position, the examiner’s left hand is placed on the patient’ s right flank, an assistant (another person) places one hand on the middle of the abdomen to prevent the transmission of any wave through the tissues of the abdominal wall
18The examiners’s right hand then lightly taps the left flank of the patient, in the presence of a significant amount of ascites, a wave will be transmitted through the fluid to the examiner’s left hand as a sharp impulse.
27normal liver upper limit 5th intercostal space lower border --costal margin diameter of dullness 9-11cm enlargement of liver dullness hepatitis, hepatic carcinoma hepatic cyst hepatic abscess hepatic engorgement
28Decreased liver dullness cirrhosis of liver, hepatonecrosis absence of liver dullness perforation of hollow viscus interposition of hepatic flexure of colon percussive pain of liver hepatitis hepatic abscess percussive pain of gallbladder cholecystitis
44Vein bruit periumbilicus, upper abdomen or over the liver: continuous humming sound, seen in portal hypertension caused by cirrhosis of liver Friction rub over the spleen or over the liver perisplenitis caused by spleen infarction perihepatitis
45Scratch sound exploration of hepatic lower edge auscultary percussion auscultary scratch exploration of small quantity of ascites about 120 ml
46The main symptoms and signs of abdominal common diseases
47Gastric and Duodenal Ulcer In etiology, gastric and duodenal ulcer always have relation to hydrochloric acid and pepsin, so they are also called Peptic Ulcer
48Symptoms Chronic pigastric pain is main symptom of peptic ulcer The pain has following features
491 Location and Extent The pain from gastric ulcer is just under xiphoid or left, but duodenal ulcer is located in the middle of epigastrium or right. The extent of the pain is just like a palm size.
502 The character of pain The character of pain is frequently described as burning, blunt or hunger pain. The pain is continuous, often lasting 1-4h.
513 Chronicity and Recurrence of peptic ulcer, some patients with peptic ulcer are reported annual recurrence of pain during particular seasons, such as spring or autumn, especially early spring or late autumn
524 The rhythmicity of pain The pain from peptic ulcer has certain relation to meals The pain from gastric ulcer often occurs at 0.5-2h after meals, disppear until next meal. The rhythmicity of pain is meal-pain-remission
53The pain from duodenal ulcer often occurs at 2-3h after meal, until next meal, so the rhythmicity of pain is pain-meal-remission, so called hunger pain and the pain usually occurs at bed time or midnight, so called nocturnal pain.
54Other symptoms in addition to pain, the patient with peptic ulcer may have other symptoms such as nausea, vomiting, heartburn, weight loss and so on.
55Signs During remission, on signs can be found, but in active peptic ulcer, most frequently there is a epigastric tenderness, the point of tenderness is just the same as the location of peptic ulcer.
56Complications Bleeding Perforation Obstruction Gastric cancer