The abdomen

Introduction to Clinical Skills

The Abdomen

Universidad Iberoamericana UNIBE

Introduction to Clinical Skills

Midterm Exam General appearance Vital signs Integumentary System HEENT and Neck Thorax, Lungs and CVC System Breast and Axillae

Introduction to Clinical Skills

Teaching Staff Dra Elizabeth Peralta Dr Marcos Núñez Dra Cristina Páez C Dr Juan Carlos Mariñez Dra Wayna Greo Dra Yun Pey Lee

Introduction to Clinical Skills

The Abdomen: anterior-posterior Anatomy and physiology Landmarks

Introduction to Clinical Skills

Introduction to Clinical Skills

Introduction to Clinical Skills

Introduction to Clinical Skills

Introduction to Clinical Skills

Introduction to Clinical Skills

The Abdomen: anterior-posterior Anatomy and physiology Landmarks

Introduction to Clinical Skills

The Abdomen: Health Promotion and Counseling Screening for alcohol abuse

USA: 8.5% population = 17.6 million people CAGE questions

Risk factors for Hepatitis A, B, and C Immunizations Transfusions

Screening for Colon Cancer PMH: IBD, adenomatous polyps Family history

Introduction to Clinical Skills

The Abdomen: Health Promotion and Counseling CAGE questions Have you ever felt the need to Cut Down on drinking ? Have you ever fel Annoyed by criticism of your drinking ? Have you ever gelt Guilty about drinking ? Have you ever taken a drink first thing in the morning (Eye-

opener) to steady your nerves or get rid of a hangover ?

Introduction to Clinical Skills

Gastrointestinal Disorders Abdominal pain, acute and chronic Indigestion, nausea, vomiting, loss of

appetite, early satiety Dysphagia and/or odinophagia Change in bowel function Diahrrea, constipation Jaundice

Urinary Disorders Suprapubic pain Dysuria, urgency, or frequency Hesitancy, decreased stream in males Polyurea or nocturia Urinary incontinence Hematuria Kidney or flank pain Ureteral colic

Introduction to Clinical Skills

The Abdomen: Pattern and Mechanisms of Abdominal Pain Visceral pain

Hollow viscus distention Solid organs capsule stretch Difficult to localize

Parietal pain Inflammation parietal peritoneum More sever, localized

Referred pain Distant sites Same spinal nerves as the disordered structures

Introduction to Clinical Skills

Introduction to Clinical Skills

Introduction to Clinical Skills

The Abdomen: anterior-posterior Inspection Auscultation Percussion Palpation

Introduction to Clinical Skills

The Abdomen: anterior-posterior Inspection. Tips for the Examination

Empty bladder Supine position, comfortable Flex hips and knees Warm hands and stethoscope Identify painful areas Distraction as necesary

Introduction to Clinical Skills

The Abdomen: anterior-posterior Inspection

Skin: Scars, striae, dilated veins, rashes and lesions Umbilicus: Contour and location Shape-contour; Symmetric, flat scaphoid, prominent Peristalsis (visible) Pulsations (Aorta)

Introduction to Clinical Skills

The Abdomen: anterior-posterior Auscultation: 4 quadrants

Peristalsis Bruits

Introduction to Clinical Skills

The Abdomen: anterior-posterior Percussion

Timpany Dullnes

Introduction to Clinical Skills

The Abdomen: anterior-posterior Palpation: muscle tone, pain

Light palpation Deep palpation Assessment for peritoneal inflammation

Introduction to Clinical Skills

The Abdomen: anterior-posterior The Liver

Percussion Liver span

Palpation: right side

Introduction to Clinical Skills

The Abdomen: anterior-posterior The Liver

Percussion Liver span

Palpation: right side

Introduction to Clinical Skills

The Abdomen: anterior-posterior The Spleen

Percussion Palpation: left side

Introduction to Clinical Skills

The Abdomen: anterior-posterior The Kidneys

Costovertebral tenderness test Clench fist test Bimanual palpation

Introduction to Clinical Skills

The Abdomen: anterior-posterior Assessment Techniques for:

Ascites Appendicitis Acute cholecystitis Ventral hernia Mass in abdominal wall Pregnancy

Introduction to Clinical Skills

The Abdomen: anterior-posterior Pelvic Organs

Bladder Internal Genitalia

Retroperitoneal Organs Kidneys Adrenals Aorta / IVC

Thoracolumbar Spine Xifosis Lordosis

Introduction to Clinical Skills

The Abdomen: anterior-posterior Pelvic Organs

Bladder Internal Genitalia

Retroperitoneal Organs Kidneys Adrenals Aorta / IVC

Thoracolumbar Spine Xifosis Lordosis

Introduction to Clinical Skills

The Abdomen: anterior-posterior Pelvic Organs

Bladder Internal Genitalia

Retroperitoneal Organs Kidneys Adrenals Aorta / IVC

Thoracolumbar Spine Xifosis Lordosis

Introduction to Clinical Skills

Recording your findings “Abdomen is protuberant with active bowel sounds.It is soft and

nontender, no palpable masses or heaptosplenomegaly. Liver span is 7cm in the right LCL, edge is smooth and palpable 1 cm below the right costal margin. Spleen and kidneys not felt. No costovertebral angle (CVA) tenderness”

Introduction to Clinical Skills