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Winter Quarter 2010 Adapted from previous years by Amanda Kocoloski, OMS IV Abdominal Exam.

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Presentation on theme: "Winter Quarter 2010 Adapted from previous years by Amanda Kocoloski, OMS IV Abdominal Exam."— Presentation transcript:

1 Winter Quarter 2010 Adapted from previous years by Amanda Kocoloski, OMS IV Abdominal Exam

2 Agenda  History  Anatomy  Physical  Practice cases  2 gastrointestinal complaints  Work on incorporating GI into history and physical exam skills  Practice documentation

3 History Common Complaints:  Abdominal pain  Change in appetite  Dysphagia/Odynophagia  Difficult or painful swallowing  Nausea/Vomiting  Jaundice  Change in bowel habits  Melena/Hematochezia  Dark tarry or red stools  Hemorrhoids  Anal pruritis 3

4 Anatomy Regions (Anatomical)Quadrants (Clinical) 4

5 Surface Anatomy 5

6 Enhancing the Exam  Empty bladder  Patient comfort (pillows and draping)  Arms at side or crossed over chest  Ask the patient to point to any painful areas; examine last  Warm hands and stethoscope  Ticklish or nervous patients: slow movements, distraction, use their hands 6

7 Exam Order  Inspection  Auscultation  Percussion or palpation can alter bowel sound frequency  Bonus Question: What is the medical term for “stomach growling”?  Borborygmus  Percussion  Palpation 7

8 Abdominal Physical Exam Inspection  Contour  Flat  Scaphoid  Distended  Symmetry  Movement  Peristaltic  Respirations  Aortic pulsation  Skin  Scars – cicatrix  Striae  Discoloration  Venous patterns  Edema 8

9 Abdominal Physical Exam Auscultation  4 quadrants  seconds  Bowel sounds  Frequency  Pitch  Vascular Sounds  Renal  Iliac  Femoral 9

10 Abdominal Physical Exam Percussion  Notes Elicited  Tympanic  Predominant due to gas in GI tract  Hyperresonant  Dull  Organs, fluid and feces  Flat  Distension of abdomen  Fluid vs. Air  Outline Organs  Liver, spleen, and gastric bubble 10

11 Abdominal Physical Exam Palpation  Start farthest from pain and move towards it  4 abdominal quadrants  Light palpation  Deep palpation  Peritoneal inflammation  Pain with coughing, gentle palpation  Involuntary rigidity  Rebound tenderness 11

12 Abdominal Physical Exam Palpation - Left Upper Quadrant  Liver: left lobe  Spleen  Stomach  Jejunum and proximal ileum  Pancreas: body and tail  Left kidney  Left suprarenal gland  Left colic (splenic) flexure  Transverse colon: left half  Descending colon: superior part 12

13  Liver: left lobe  Spleen  Stomach  Jejunum and proximal ileum  Pancreas: body and tail  Left Kidney  Left Suprarenal gland  Left colic (splenic) flexure  Transverse colon: left half  Descending colon: superior part 13 Abdominal Physical Exam Palpation - Left Upper Quadrant

14 Abdominal Physical Exam Palpation - Right Upper Quadrant  Liver: right lobe  Gallbladder  Stomach: pylorus  Duodenum: parts 1-3  Pancreas: head  Right suprarenal gland  Right kidney  Right colic (hepatic) flexure  Ascending colon: superior part  Transverse colon: right half 14

15 Abdominal Physical Exam Palpation - Right Upper Quadrant  Liver: right lobe  Gallbladder – Murphy’s sign  Stomach: pylorus  Duodenum: parts 1-3  Pancreas: head  Right suprarenal gland  Right kidney  Right colic (hepatic) flexure  Ascending colon: superior part  Transverse colon: right half 15

16 Abdominal Physical Exam Palpation - Right Lower Quadrant  Cecum  Vermiform appendix  McBurney’s point  Rovsing’s sign  Psoas sign  Obturator sign  Most of ileum  Ascending colon: inferior part  Right ovary  Right uterine tube  Right spermatic cord  Uterus (if enlarged)  Urinary bladder (if full) 16

17 Abdominal Physical Exam Palpation - Right Lower Quadrant  Cecum  Vermiform appendix  McBurney’s Point  Rovsing’s sign  Psoas sign  Obturator sign  Most of ileum  Ascending colon: inferior part  Right ovary  Right uterine tube  Right spermatic cord  Uterus (if enlarged)  Urinary bladder (if full) 17

18 18 Walgreens.com

19 Abdominal Physical Exam Palpation - Left Lower Quadrant  Sigmoid colon  Descending colon: inferior part  Left ovary  Left uterine tube  Left ureter: abdominal part  Left spermatic cord: abdominal part  Uterus (if enlarged)  Urinary bladder (if full) 19

20 Abdominal Physical Exam Palpation - Left Lower Quadrant 20  Sigmoid colon  Descending colon: inferior part  Left ovary  Left uterine tube  Left ureter: abdominal part  Left spermatic cord: abdominal part  Uterus (if enlarged)  Urinary bladder (if full)

21 Extras  Abdominal Aorta  Inguinal Lymph Nodes  Costovertebral angle (CVA) tenderness 21

22 Abdominal Physical Exam Practice- 20 Minutes Inspection – Contour – Skin – Movement Auscultation – Bowel sounds – Vascular sounds Percussion – Abdomen for masses or fluid – Liver span – Spleen – Gastric bubble Palpate – General palpation – Liver – Gallbladder – Spleen – R and L kidneys – Abdominal aorta – Inguinal lymph nodes Special: – Murphy’s sign – McBurney’s point – Rovsing’s sign – Psoas sign – Obturator sign – Rebound tenderness – CVA tenderness 22

23 Practice Cases 45 minutes

24 Practice Documentation 15 minutes

25 Questions? Have a great winter break!


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