Beruflich Dokumente
Kultur Dokumente
Example of Pregnancy
B. SCARS
STRIAE
- multiple 1-6 cm long
- Run axially under epidermis
- pink or blue silvery
- chronic stretching skin rupture of elastic fibers in reticular
layer
- abdomen, thigh, shoulder, breast
- eg: pregnancy, obesity, ascites
SEQUENCE OF EXAMINATION OF ABDOMEN
- Inspection *
- Auscultation
- Percussion
- Palpation *
- Assessment of the liver, spleen & kidneys
- (+/-) rectal exam
VISION 20|20
AD ASTRA PER ASPERA 1 OF 4
CLINICAL DIAGNOSIS B PHYSICAL DIAGNOSIS LECTURE – ABDOMEN (INSPECTION)
o Small Intestine & Large Intestine obstruction
o thin persons
Borborygmi
- intestinal rumbling, stomach growling, prolonged gurgles of
hyperperistalsis
- intestinal rumbling w/o stethoscope + pain → intestinal
obstruction
Example of Keloid Scar - intestinal rumbling w/o stethoscope + without pain → hungry
C. ENGORGED VEINS
- scarcely visible E. PULSATIONS
- if visible may indicate SP >/= 120 mmHg - normal abdominal aorta causes slight pulsation in the
- CLINICAL OCCURENCE epigastric
o above the umbilicus → ↑blood flow - amplification ↑ in widened pulse, tortuous aorta or aneurysm
o below the umbilicus→ ↓blood flow - Clinical Occurrence
o IVC obstruction = flow is ↑ from lower abdomen o Widened pulse pressure arterial hypertension
o Portal obstruction = upper abdomen has Normal o Aortic aneurysm (especially in elderly > 65 years old)
upward flow o Thyrotoxicosis
o SVC obstruction = ↑ flow in upper abdomen o Tortuous aorta
o Solid mass overlying the aorta
o AR
F. UMBILICUS
- Flat
- Everted: without hernia, a sign of ↑intra-abdominal Pressure
(tumor, ascites, pregnancy)
- Inverted: more deeply inverted in obese
- Clinical Occurrence
Example of Superficial Veins o Umbilical fistula – (+/-) abnormal discharge
▪ urine = patent urachus
▪ pus = urachal cyst or intraabdominal abscess
▪ feces = connection for the colon
o Umbilical calculus
▪ hard mass of dirt
o Nodular umbilicus (Sis Mary Joseph)
▪ abdominal CA especially gastric CA
with metastasis to the navel
Example of Caput Medussae o Bluish umbilicus (Cullen’s sign)
Caput Medussae ▪ bluish discoloration of navel due to
- Dilated subq Veins retroperitoneal hemorrhage
- Severe portal hypertension due to liver cirrhosis
- Massive ascites and umbilicus not seen
Spider Angiomas
- Dilated Arteriole
D. PERISTALSIS
- slow undulations under skin
- light source from feet to head or across the abdomen
- examiner sits at the R side of patient, head slightly higher > Sis Mary Joseph Cullen’s Sign
abdomen
- seen in thin abdominal wall G.ECCHYMOSES
- Clinical occurrence of peristalsis: - Grey Turner’s Sign
o pyloric obstruction o on abdomen and flanks
VISION 20|20
AD ASTRA PER ASPERA 2 OF 4
CLINICAL DIAGNOSIS B PHYSICAL DIAGNOSIS LECTURE – ABDOMEN (INSPECTION)
o discoloration due to ecchymosis in lower abdomen and o Palpation and percussion will also possibly alter
flanks observations made in inspection and auscultation
o due to infiltration extra peritoneal T with blood - 6Fs
→ retroperitoneal bleeding o Fats
- Clinical Occurrences: o Fluids
o hemorrhagic pancreatitis o Fetus
o strangulated bowels o Feces
o hemorrhages from abscesses o Flatus
o Myocardial infarction in myxedema o Fatal growths
- Fats:
o Obesity: navel is inverted
- Fluids:
o Ascites (abdominal dropsy): navel is everted
o Bulging flanks: (+) fluid wave
o Shifting dullness: pathognomonic
o Puddle sign: detect 120 ml fluid
Grey Turner’s Sign - Fetus
H. JAUNDICE o Pregnancy: missed period, Breasts engorged, (+) fetus
- staining of body T & fluids by bile pigments - Feces:
- conjugated & unconjugated bilirubin o large amount of feces (megacolon) distention
- most intense on the face, trunk & sclera
- 1st seen in frenulum
- conjugated bilirubin (B2) is 2-4 mg%
- Intrinsic or Acquired Disease cause
- Causes of Jaundice:
o RBC abnormality hemolysis
▪ Intrinsic: G6PD deficiency, sickle cell anemia
▪ Extrinsic or acquired: methyldopa, leukemia,
ABO-Rh incompatibility
o Hepatic Disorder Obesity Ascites Pregnancy
▪ Intrinsic: Gilbert’s, Crigler-Najjar syndrome
▪ Extrinsic: viral hepatitis, drugs - Flatus
o Biliary obstruction o Tympanitic (meteorism)
▪ Stones ▪ ↑ gas in stomach & intestine
▪ CA ▪ abdominal distention + tympanitic
▪ Strictures o Mechanical (local) obstruction= high or low
▪ hyperactive Bowel Sounds/ borborygmi
▪ colicky pain
▪ high obstruction
• vomitus is bile stained
• distal to 2nd portion of duo
▪ low obstruction
• fecal vomitus
• colonic obstruction
o Non-mechanical (diffuse) ileus
▪ hypoactive Bowel Sounds or absent Bowel Sounds
VISION 20|20
AD ASTRA PER ASPERA 3 OF 4
CLINICAL DIAGNOSIS B PHYSICAL DIAGNOSIS LECTURE – ABDOMEN (INSPECTION)
Clinical Occurrences of ileus:
- Surgical or trauma: post-op
- Chemicals: HCl, gastric contents from perforated stomach
or duodenum
- Metabolic: hypokalemia, DKA
- Mechanical: adhesions, tumors, megacolon
J. ABDOMINAL HERNIA
- Protrusion due to weak point in abdominal wall
- Reducible: contents in the sac replaced
- Irreducible/incarcerated: cannot be pushed back
- Strangulated: blood supply interrupted →gangrene
o bowels firm but not tender
o don’t use force →rupture
VISION 20|20
AD ASTRA PER ASPERA 4 OF 4