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Abdominal Examination (Gastrointestinal Tract Examination)

Abdominal Examination (Gastrointestinal Tract Examination) : Inspection, Palpation, Percussion, & Auscultation

Systemic examination of abdomen is as following:

A. Inspection

Shape of abdomen

Movements with respiration (Quadrants of abdomen)

Visible peristalsis

Skin or Surface of Abdomen

  • Dilated or engorged veins (Part of abdomen, Direction of flow)
  • Caput medusae
  • Purple striae
  • Striae atrophica or gravidarum

Hernial orifices

Divarication of recti

Measurements

  • Abdominal girth
  • Distance between lower end of xiphisternum to umbilicus and from umbilicus to symphysis pubis

Scrotum

B. Palpation

Superficial

  • Tenderness
  • Rigidity

Deep

Start in left iliac fossa palpating lightly and working anti-clockwise to end in suprapubic region. The order of palpation of organs are:

  • Left kidney
  • Spleen
  • Right kidney
  • Liver
  • Urinary bladder
  • Aorta and para-aortic glands and common iliac vessels
  • Palpate both groins
  • Examine external genitalia

Describe about size, surface, margins, consistency, tenderness.

C. Percussion

Organ percussion

  • Liver
  • Spleen
  • Any other lump

Percussion for free fluid in abdomen

  • Fluid thrill (This is felt when there is a large amount of fluid under tension, i.e. > 2000 ml)
  • Shifting dullness (About 1000 ml of fluid should be present to elicit this sign)
  • Horse-shoe shaped dullness
  • Puddle sign (It can detect as little as 120 ml of ascitic fluid)

Percussion of Cyst

  • Hydatid Thrill

D. Auscultation

What to observe?

Bowel sounds (peristaltic sounds)

Arterial bruit

Paraxiphoid venous hum

Friction rub (Hepatic/Splenic)

Succussion splash

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