Examination of the Abdomen

Inspection of the abdomen: assess shape, size, symmetry, participation in the breathing, umbilicus position, expression of the subcutaneous veins, scars, eruptions, scratches, visible pulsation, peristalsis, teleangioectasia.

Palpation of the abdomen

Superficial tentative oriental palpation

Identify muscular resistance, abdominal tenderness, diastesis recti, fluctuation sign, Shchetkin-Blumberg sign, Mendel sign.

Deep palpation:

Characteristics of the abdominal organs: localization, diameter, density, the condition of surface (smooth, tubercular), tenderness, mobility, rumbling sounds.

Describe all palpated organs in sequence:

- the sigmoid,

- the caecum,

- the ascending,

- the descending colons,

- the stomach after determination of lower border of stomach position using one of the methods:

1. Percussion method (above a stomach the percussion sound is low timpanic sound, above an intestine is high timpanic sound. The place of transition of low timpanic sound in high timpanic – is the the position of the lower boder of stomach)

2. Palpation method – the narrow cylinder is palpated in the place which was determinated by percussion

3. Percussion-auscultation method (Doctor puts the phonendoscope on the epigastric region nearer to the left costal arc, and performs easy percussion strike from a xifoid process on the white line of abdomen downward. Above a stomach sounds in phonendoscope are audible. In area of lower than border of stomach sounds disappear)

4. Percussion-palpation method (“splash noise”) - patient must drinkat 300-400 ml liquids on an empty stomach, a doctor puts a left hand in a low part of sternum, by a right hand executes motions (shoves) – “sucussio”. Above a stomach the «splash noise» is heard, at the level of large curvature the «splash noise» disappears.

In a norm the lower border of stomach is located at men – on 3-4 cm higher than umbilicus, at women – on 1-2 cm higher than umbilicus.

- the transverse colon,

- the liver – describe of the lower edge if it is palpated,

- the spleen,

- the pancreas.

Percussion of the liver according to M.G. Kurlov:

1. Percuss downward from the chest along the right midclavicular line until you detect the top edge of liver dullness (upper border of liver).

Percuss upward from the abdomen along the same line until you detect the bottom edge of liver dullness.

Measure the first liver span between these two points. This value should be 9±2 cm (in a normal adult.

2. Imagine midstemal line and perpendicular line from the upper border of the liver to the sternum. Find the point at the intersection of these lines.

Percuss upward from the abdomen along the midsternal line until you detect the bottom edge of liver dullness.

Measure the first liver span between these two points. This measurement should be 8±2 cm in a normal adult.

3. Percuss over the left last rib and find the left border of the liver. Measure from this point to the point of intersection as described in the previous paragraph. This value should be 7±2 cm in a normal adult.

Checking gallbladder affecting signs.

- the Kerr’s sign (pain at deep palpation of gall-bladder bottom)

- the Ortner’s sign (pain at percussion over the right costal arch

- the Lepene-Vasylenko’s sign (pain at percussion on the front wall of stomach on the right parallel to the right costal arch)

- the Mussy-Georgyevskiy’s sign (frenicus) - pain at deep palpation between the legs of right m.sternocleidomastoideus

- the Merphy’s sign (pain and breaking (stop) of inspiration during deep palpation of projection point of the gall-bladder bottom)

Дата добавления: 2015-11-14