1. PEMERIKSAAN ABDOMEN PSIK FIKES UMM

2. 1.The patient should have an empty bladder. 2.The patient should be lying supine on the exam table and appropriately draped. 3.The examination room must be quiet to perform adequate auscultation and percussion. 4.Watch the patient's face for signs of discomfort during the examination. 5.Use the appropriate terminology to locate your findings 6.Disorders in the chest will often manifest with abdominal symptoms. It is always wise to examine the chest when evaluating an abdominal complaint. 7.Consider the inguinal/rectal examination in males. Consider the pelvic/rectal examination in females. EXAM SECTIONS 1.Inspection 2.Auscultation 3.Percussion 4.Palpation General Considerations

3. Physicians locate findings in the abdomen in one of four quadrants or one of nine regions. The four quadrants are: right upper (RUQ), right lower (RLQ), left upper (LUQ) and left lower (LLQ). THE NINE REGIONS epigastric, umbilical, hypogastric/suprapubic, right hypochondriac, left hypochondriac, right lumbar, left lumbar, right inguinal and left inguinal. 1. INSPECTION

4. LOCATIONS of ABDOMINAL ORGANS The schematic below is a reminder of what organs are likely to produce findings in each region. For example: –Right hypochondriac (RUQ) : liver and gall bladder –left hypochondriac (LUQ) : the spleen and stomach –epigastric : the pancreas, stomach and common bile duct –umbilical : the small intestine –lumbar : the kidneys –iliac regions : the ovaries –left iliac/LLQ : the sigmoid colon –right iliac or lumbar (RLQ): the cecum and appendix –suprapubic : the bladder and uterus

5. SOME COMMON FINDINGS on ABDOMINAL INSPECTION –Scars : Jaringan parut –Striae (stretch marks) : tanda peregangan  ibu hamil –Colors : - Bluish color at the umbilicus is Cullen's sign – a sign of bleeding in the peritoneum. - Bruises on the flanks are Grey Turner's sign (retroperitoneal bleeding - e.g. from inflamed pancreas) –Jaundice : warna kuning pada kulit –Prominent veins : may be due to portal vein obstruction or inferior vena cava obstruction

6. ABDOMINAL DISTENSION Distension of the lower abdomen only can be caused by pregnancy, full bladder, ovarian tumor, or uterine fibroids (common benign growths) Diffuse abdominal distension can be caused by any of the 6 Fs: –Fat (obesity) –Fluid (ascites - peritoneal fluid - or obstructed viscera filled with fluid) –Flatus (air) - e.g. from air swallowing or intestinal obstruction –Feces (constipation –Fetus (pregnancy) –Fatal cancer.

7. 2. AUSCULTATION GUT SOUNDS Use the diaphragm of your stethoscope to listen to gut sounds Normal gut sounds are gurgling, 5 to 35 per minute Borborygmi are loud, easily audible sounds. They are normal, too. High pitched, tinkling (raindrops in a barrel) sounds are a sign of early intestinal obstruction Decreased sounds: (none for a minute) are a sign of decreased gut activity. Gut sounds may be markedly decreased after abdominal surgery; abdominal infection (peritonitis) or injury. Absent Sounds : (no sounds for 5 minutes) are a bad sign. They can be caused by longer-lasting intestinal obstruction, intestinal perforation or intestinal (mesenteric) ischemia or infarction

8. 3. PERCUSSION What it finds: liver size (kind of), spleen, fluid. Percussing the body gives one of three notes: Tympany is found in most of the abdomen, caused by air in the gut. It has a higher pitch than the lung. Resonance is found in normal lung. It is lower pitched and hollow. Dullness is a flat sound, without echoes. The liver and spleen, and fluid in the peritoneum (ascites: ah-SY-teez), give a dull note.

9. A. Liver Span Percuss downward from the chest in the right midclavicular line until you detect the top edge of liver dullness. Percuss upward from the abdomen in the same line until you detect the bottom edge of liver dullness. Measure the liver span between these two points. This measurement should be 6-12 cm in a normal adult. B. Splenic Dullness Percuss the lowest costal interspace in the left anterior axillary line. This area is normally tympanitic. Ask the patient to take a deep breath and percuss this area again. Dullness in this area is a sign of splenic enlargement.

10. Shifting Dullness This is a test for peritoneal fluid (ascites). ++++ Percuss the patient's abdomen to outline areas of dullness and tympany. Have the patient roll away from you. Percuss and again outline areas of dullness and tympany. If the dullness has shifted to areas of prior tympany, the patient may have excess peritoneal fluid. Psoas Sign This is a test for appendicitis. ++++ Place your hand above the patient's right knee. Ask the patient to flex the right hip against resistance. Increased abdominal pain indicates a positive psoas sign. Obturator Sign This is a test for appendicitis. ++++ Raise the patient's right leg with the knee flexed. Rotate the leg internally at the hip. Increased abdominal pain indicates a positive obturator sign.

11. 4. PALPATION General Palpation 1.Begin with light palpation. At this point you are mostly looking for areas of tenderness. The most sensitive indicator of tenderness is the patient's facial expression (so watch the patient's face, not your hands). Voluntary or involuntary guarding may also be present. 2.Proceed to deep palpation after surveying the abdomen lightly. Try to identify abdominal masses or areas of deep tenderness

12. Palpation of the Liver Standard Method Place your fingers just below the right costal margin and press firmly. Ask the patient to take a deep breath. You may feel the edge of the liver press against your fingers. Or it may slide under your hand as the patient exhales. A normal liver is not tender. Alternate Method This method is useful when the patient is obese or when the examiner is small compared to the patient. Stand by the patient's chest. "Hook" your fingers just below the costal margin and press firmly. Ask the patient to take a deep breath. You may feel the edge of the liver press against your fingers.