The Abdomen without notes 2018rev(1).pptx

No vaccine available screening counseling adverse

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No vaccine available Screening & counseling Adverse Outcomes Liver cirrhosis HCC Cure Antiviral therapy-Harvoni
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SCREENING FOR COLORECTAL CANCER 33 Common high-risk conditions (25% of colorectal cancers) Personal history of colorectal cancer or adenoma 1 st degree relatives colon ca or precancerous polyps Personal history of breast, ovarian, or endometrial ca Personal history of UC or Crohn’s disease Hereditary high-risk conditions (6% of colorectal cancers) Hereditary non-polyposis colorectal cancer Familial adenomatous polyposis Screening Recommendations Age 50-75 yrs-options FOBT annually Flexible sigmoidoscopy with FOBT every 3 yrs Screening colonoscopy every 10 yrs.
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SEQUENCE OF THE ABDOMINAL EXAM Inspection Auscultatio n Percussion Palpation 34
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EXAMINATION OF THE ABDOMEN “MUST HAVES” Good Lighting Relaxed Patient Well- Draped Patient Visible Groin Area Relaxed Abdominal Muscles 35
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IMPORTANT TIPS FOR EXAMINING THE ABDOMEN 36 Check if the patient has an empty bladder. Make the patient comfortable in the supine position, With a pillow under the head and perhaps another under the knees. Slide your hand under the low back to see if the patient is relaxed and lying flat on the table. Ask the patient to keep arms folded across the chest. Ask the patient for any areas of pain prior to beginning exam Warm your hands and Stethoscope Approach the patient calmly and avoid quick, unexpected movements. Distract the patient, if necessary, with conversation or questions.
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INSPECTION 37 Skin- Umbilicus Contour of the Abdomen
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AUSCULTATION Motility Auscultation provides important information about bowel motility. Bruits/Vascular Sounds Resembling heart murmurs, over the aorta or other arteries in the abdomen Clicks, Gurgles The is normal and should occur at a frequency of 5 to 34 per minute Borborygmi Prolonged gurgles of hyper-peristalsis, the familiar “stomach growling.” 38
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ADDITIONAL SOUNDS OF THE ABDOMEN ABDOMINAL BRUITS & FRICTION RUB 39 Friction Rubs-listen with diaphragm Bruits-listen with bell of stethoscope Arterial Bruits indicates possible partial occlusion
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PALPATION Light Palpation Eliciting abdominal tenderness, muscular resistance, Identify some superficial organs &masses. It also serves to reassure and relax the patient Deep Palpation This is usually required to delineate abdominal masses. Using the palmar surfaces of your fingers, press down in all four quadrants. Identify any masses; note their location, size, shape, consistency, tenderness, pulsations, and any mobility with respiration or pressure from the examining hand. 40
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PALPATION 41 Light Palpation Deep Palpation
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SIGNS OF PERITONITIS Positive Cough Test guarding Rigidity Rebound tenderness 42
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ASSESSING FOR PERITONITIS Palpate gently Check for guarding , rigidity, and rebound tenderness Ask the patient: “Which hurts more”-pressing in or the release.
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