1. ABDOMINAL EXAMINATION

2. Anatomy
Regions
Common presenting symptoms
Examination
Inspection
Auscultation
Percussion
Palpation
Liver and spleen
5. Specific maneuvers

6. Regions

7. Common presenting symptoms of Gastrointestinal disorders
Abdominal pain, acute or chronic
Indigestion, nausea, vomiting including blood, loss of appetite, early satiety
Dysphagia / odynophagia
Diarrhea, constipation
Jaundice
For each symptom, try to elicit all of its attributes
SOCRATES (site, onset, character, radiation, associated factors, timing, exacerbating/relieving factors, severity)

8. Example: Typical pain in Acute appendicitis
Site: poorly localized, periumbilical pain followed usually by RLQ pain
Onset: vague
Character: dull periumbilical pain, may be cramping
Radiation: periumbilical  RLQ
Associated factors: anorexia, nausea/vomiting, low fever
Timing: Periumbilical (4-6h), RLQ (depends on intervention)
Exacerbating/relieving factors: if subsides temporarily, suspect perforation of the appendix, movement/cough.
Severity: periumbilical (mild but increasing), RUQ (steady/more severe)

9. Inspection The skin: scar, striae, dilated vein, rashes and lesions
The umbilicus: contour, inflammation, bulges
The contour of the abdomen: flat, rounded, protuberant, scaphoid
Peristalsis
Pulsations: abdominal aorta in the epigastric region.

10. SCAR

11. PINK-PURPLE STRIAE OF CUSHING’S SYNDROME

12. DILATED VEIN OF HEPATIC CIRRHOSIS

13. RASHES

14. UMBILICAL HERNIA IN NEWBORN

15. Contour of the abdomen SCAPHOID PROTUBERANT
(newborn with diaphragmatic hernia)
PROTUBERANT

16. AUSCULTATION
Before performing percussion and palpation because these maneuvers can alter the bowel sound
Bowel sounds (5-34/min)
diarrhea, intestinal obstruction
paralytic ileus, peritonitis
Bruits (renal artery stenosis)

19. PERCUSSION Percuss lightly in all four quadrant
Distribution of tympany and dullness.

21. PALPATION
Light palpation: tenderness, muscular resistance, superficial organs and masses.
Deep palpation: delineate abdominal masses
Assessment for peritoneal inflammation:
Cough  Palpation (guarding, rigidity)  rebound tenderness

23. LIVER
Percussion
Palpation

25. SPLEEN Percussion: 2 techniques
Percuss the left lower anterior chest wall
Check splenic percussion sign
Palpation

27. Time for test!

28. A

29. D

30. C

31. C

33. “Abdomen is protuberant with active bowel sounds
“Abdomen is protuberant with active bowel sounds. It is soft and non-tender; no masses or hepatosplenomegaly. Liver span is 7 cm in the right midclavicular line; edge is smooth and palpable 1 cm below the right costal margin. Spleen not felt”
“Abdomen is flat. No bowel sounds heard. It is firm and boardlike, with increased tenderness, guarding, and rebound in the right midquadrant. Liver percusses to 7 cm in the midclavicular line; edge not felt. Spleen not felt”

34. VN  English Ăn uống bình thường, đi cầu bình thường
Không đau bụng, không nôn, không buồn nôn
Bụng không chướng,
Âm ruột bình thường, không nghe tiếng thổi động mạch
Bụng mềm, không đau, không sờ thấy u cục
Gan 1cm dưới bờ sườn, cao 8 cm trên đường trung đòn, lách không lớn
No anorexia (no change in dietary patterns), no diarrhea or constipation (no abnormalities in stool patterns or characteristics)
No abdominal pain, no nausea or vomiting
No abdominal distension
Bowel sounds present (active bowel sounds), no bruits
Abdomen soft and non-tender, no masses,
Liver span is 8 cm in the right midclavicular line, edge is palpable 1 cm below the RCM
Speen not felt (no spleenomegaly)