Presentation on theme: "4. Palpation of masses the masses of abdomen may be caused by enlarged organ ectopic organ cyst carcinoma inflammatory tissues enlarged lymphnode."— Presentation transcript:
4. Palpation of masses the masses of abdomen may be caused by enlarged organ ectopic organ cyst carcinoma inflammatory tissues enlarged lymphnode
(1)Normal masses of abdomen tendon of abdominal rectus lumber vertebral body sacral promontory sigmoid colon transverse colon cecum
(2).Abnormal mass of abdomen when you palpate the mass of abdomen you should describe the location size contour consistency tenderness pulsation mobility
The 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.
big mass without intestinal obstruction, the mass originate from mesentery peritoneum omentum postperitoneum
The 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.
Big 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.
The 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
※ 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
The consistency of mass ※ soft mass cyst, abscess ※ middle hard inflammatory mass ※ hard tumor the tenderness of mass ※ severe tenderness inflammatory mass ※ light tenderness tumor
The pulsation of mass ※ abdominal aneurysm or a mass next to the aorta ※ enlargement of liver with pulsation tricuspid valve incompetence
The 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
※ 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
5. 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
The 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.
6. Succussion splash
Succussion splash this examining method can check for retention of gastric fluid. If succussion splash is positive after meal 6-8 hours indicating pyloric obstruction
Percussion can check for the presence of abdominal distention, tumor, fluid, enlargement of viscera. percussion tone of abdomen liver spleen dullness flatness remains tympany
Percussion of liver --upper margin
Percussion of liver --lower margin
normal liver upper limit 5 th intercostal space lower border --costal margin diameter of dullness 9-11cm enlargement of liver dullness hepatitis, hepatic carcinoma hepatic cyst hepatic abscess hepatic engorgement
Decreased 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
Percussion of spleen normal left midaxillary line 9 th –11 th intercostal space width 4-7cm enlargement of splenic dullness: splenomegaly
traube area tympanitic area of stomach
Percussion of kidney percusive pain of kidney nephritis glomerulonephritis pyelothiasis perirenal abscess percussion of bladder distended bladder dullness disappear after urination
Percussion of ascites shifting dullness >1000ml elbow-knee position check for small amount ascites
differentiate massive ovariocyst from ascites ovariocyst dullness locate center abdomen no shifting dullness ruler pressing test ( ＋ )
vascular bruit systolic bruit partial occlusion of renal artery above umbilicus left or right side hepatic cancer lesion area abdominal aneurysm or partial occlusion of abdominal aorta
Vein 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
Scratch sound exploration of hepatic lower edge auscultary percussion auscultary scratch exploration of small quantity of ascites about 120 ml
The main symptoms and signs of abdominal common diseases
Gastric and Duodenal Ulcer In etiology, gastric and duodenal ulcer always have relation to hydrochloric acid and pepsin, so they are also called Peptic Ulcer
Symptoms Chronic pigastric pain is main symptom of peptic ulcer The pain has following features
1 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.
2 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.
3 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
4 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
The 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.
Other symptoms in addition to pain, the patient with peptic ulcer may have other symptoms such as nausea, vomiting, heartburn, weight loss and so on.
Signs 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.
Complications Bleeding Perforation Obstruction Gastric cancer