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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
