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Anatomy_Abdomin_Review - THE ABDOMEN Clinical Examination...

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www.brain101.info 1 THE ABDOMEN Clinical Examination of the Abdomen Anterior Abdominal Wall Inguinal Region Peritoneum Summary by Gut Derivatives Stomach Spleen Duodenum Pancreas Liver Gallbladder Small Intestine Large Intestine Abdominal Vasculature Nervous System Posterior Abdominal Wall Kidneys and Suprarenal Glands Lymphatic System CLINICAL EXAMINATION OF THE ABDOMEN Two kinds of pain: Visceral Pain: Deep, throbbing, delocalized pain, associated with the visceral organs. Somatic Pain : Sharp, piercing, pain localized to the abdominal wall. Abdominal Medical History: (pqr) 2 st 3 P -- Provoking: What have you noticed that makes this pain worse? P -- Palliating: What relives the pain? Q -- Quantity: How much pain are you having? Q -- Quality: What does the pain feel like? R -- Region: Where is the pain? R -- Radiation: Does the pain go (radiate) to any other locale? S -- Severity: How does it keep them from doing what they normally would do? T -- 3 time related questions o Did the pain just start (suddenly) or come on gradually? o Is the pain constant or does it come and go? o Is the first time you ever had this or have you noticed anything like this before? OBSERVE: Watch patient walk to table. Look for visible pain and discomfort. Note vital signs, stretch marks, scars, vascular pattern, etc. LISTEN (AUSCULTATE): Listen for fluid sounds -- mix of fluid and gas mixing by peristalsis. o If you hear nothing, listen up to five minutes before concluding there are no bowel sounds. It can take a while. Listen for blood flow. In some slender people you can hear turbulent flow. Listen for Friction Rub , which occurs when inflamed organs rub next to each other. Listen for transmission of sounds from chest. PERCUSSION: Best way to examine liver is by percussion, to feel for borders. Can percuss for spleen to determine if it is enlarged.
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www.brain101.info 2 PALPATE: Feel all major organs for inflammations, abnormalities, position, etc. Four Quadrants: Midsagittal Plane: Vertical line going through the middle of the abdomen. Transumbilical Plane: Horizontal line going through the umbilicus. Four Quadrants based on those planes: o Right Upper Quadrant: RUQ o Right Lower Quadrant: RLQ o Left Upper Quadrant: LUQ o Left Lower Quadrant: LLQ Nine Regions: Vertical lines of division: Left and Right Mid-Clavicular Lines Horizontal lines of division: o Transpyloric Plane : Sometimes used. It is halfway between the jugular notch and the pubic bone. o Subcostal Plane: Upper plane, passing through the inferior-most margin of the ribs. o Transtubercular Plane: The line transversing the pubic tubercle. Divisions: o Upper: Right Hypochondriac, Epigastric, Left Hypochondriac o Middle: Right Lumbar, Umbilical, Left Lumbar o Lower: Right Inguinal, Hypogastric (Suprapubic), Left Inguinal ANTERIOR ABDOMINAL WALL Boundaries of the Abdomen: Superior Boundary: The diaphragm. It extends to ICS-5 superiorly (at the median line; it is more inferior around the edges).
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