This document outlines the key steps and considerations for examining the abdomen. It discusses examining the abdomen through inspection, palpation, percussion, and auscultation. Specific symptoms related to the digestive system are also reviewed, including dysphagia, pain, heartburn, vomiting, jaundice, changes in appetite, and more. Examination of specific organs like the liver, spleen, and kidneys is described.
2. Symptoms of Digestive System:
• 1- Dysphagia: difficulty in swallowing
• Where does the food stick?
• Oral dysphagia: dry mouth, painful
condition, paresis of the tongue
• Esophageal: the food is felt to stick in
the throat or behind the sternum
• Is it worse with liquids or solids?
• Is swallowing painful „odynophagia‟?
3. Symptoms of Digestive System:
• 2- Pain
• Site
• Radiation
• Character
• Severity
• Duration
• Frequency & periodicity
• Aggravating factors
• Relieving factors
• Associated phenomena
4. Symptoms of Digestive
System:
3- Heartburn: is a burning sensation
experienced behind the sternum. In most
cases it is due to reflux of acid into the
esophagus.
4- Regurgitation: is rarely preceded by
nausea and is often effortless
5. Symptoms of Digestive System:
• 5- Vomiting
• Frequency
• Its relation to pain
• Does it relieve pain or not?
• Character of vomited matter?
• Amount
• Color: yellow color indicates bile
• Smell: foul smelling; ulcerated cancer stomach,
pyloric obst, fecal matter in intestinal obstruction
6. Symptoms of Digestive System:
• Does it contain blood?
• Does it look like “Coffee ground”?
• Does it contain residue of food taken the day
before?
• 6-Nausea: Sensation of sickness without
actual vomiting, frequently accompanied with
salivation, sweating, and feeling of faintness
7. Symptoms of Digestive System:
• 7- Hematemesis: Vomiting of blood
• May be bright red or coffee ground
• Ask about recent intake of aspirin, NSAID, alcohol,
hist of peptic ulcer or chronic liver disease.
• 8- Melena: passage of black, soft, tarry stool.
8. Symptoms of Digestive System:
• 9- Disturbance of Appetite:
• Loss of appetite (Anorexia): must be distinguished
from fear of eating because of painful condition in
the mouth or gut.
• Excessive:
• anxiety states
• Thyrotoxicosis
• DM
9. Symptoms of Digestive System:
Filling of the mouth with
• 10- Water brash:
composed of saliva.
• It is not necessarily a symptom of organic
disease.
• May be due to reflex stimulation of saliva
from GIT lesion.
usually indicates
• 11- Eructation “Belching”:
air swallowing of psychogenic origin.
May occur in organic diseases.
10. Symptoms of Digestive System:
It is a term that
• 12- Dyspepsia/ Indigestion:
usually describe a collection of
symptoms.
• Defined as pain or discomfort centered in the
upper abdomen that may be associated with
upper abdominal fullness, early
satiety, bloating, belching, or nausea.
11. Symptoms of Digestive System:
• 13- Constipation
• Normal stool frequency varies between 3 times
daily to 3 times weekly.
• What is the normal patient habit?
• Has there any recent change in habit?
• If so, can this be explained by a change in diet,
medicine….?
12. Symptoms of Digestive System:
Constipation (cont’)
• Does constipation alternate with
diarrhea?
• If so, can this be explained by taking
purgatives?
• Has he any colicky pain?
• Has he had any vomiting?
• Has he passed blood?
• Has he any weight loss?
13. Symptoms of Digestive System:
• 14- Diarrhea:
• Number
• Time of occurrence of motion during the day.
• Their relation to meals or special kind of food.
• Color of the motion
• Consistency: formed, watery, frothy
14. Symptoms of Digestive System:
• Do they float in the lavatory or difficult to
flush away? Note: pale, bulky, soft, frothy
and smelly stool is characteristic of
“Steatorrhea”
• Has he ever passed any blood?
• Does the patient use purgatives?
often accompanies diarrhea
• 15- Tenesmus:
and consists in straining with a desire to
empty the lower bowel without complete
evacuation taking place.
15. Symptoms of Digestive System:
• 16-Flatulence: the patient may complain of
winds or abdominal distension.
• 17-Bleeding per rectum:
16. Symptoms of Digestive
System:
• 18- Jaundice: Yellowish discoloration of
the skin and mucus membranes caused by the
presence in the blood of an excess of bile pigments.
• Color of urine and stool
• Itching
• History of Contact with jaundiced person.
17. Symptoms of Digestive
System:
Jaundice (cont’)
• Injection ,dental procedure, tattooing, operation,
blood transfusion.
• Drug history, Alcohol intake.
• Previous dyspepsia or biliary colic
• Hist of weight loss.
• Fever and rigors: cholangitis (stone,malign).
Usually in viral hepatitis, the fever subsides
with appearance of jaundice.
19. Local Examination
• Inspection
• Palpation
• Percussion
• Auscultation: If you want to exam for
intestinal sound, auscultation should
be done after inspection
• Pelvic, genital, and rectal
examination are part of
abdominal evaluation.
20. Anatomical Consideration
• Think anatomically:
imagine what organs live
in the area you are
examining.
• The abdomen is roughly
divided into 4 quadrants.
21.
22.
23. Think Anatomically
• Another way is to divide the abdomen into 9 areas
by:
• 2 vertical lines (MCL),
• 2 horizontal lines:
• The upper at the level of 10th costal
cartilage,
• The lower at the level of the ant.
Sup. Iliac spines
24. RHQ LHQ
Epigastric
R Lumbar L Lumbar
Umbilical
Hypogastric L Iliac
R Iliac
25. Exposure of the Abdomen
• Uncover the
abdomen from just
below the breast, to
the pelvic brim.
• Abd muscles should
be relaxed. You can
ask the pat to flex
their knees to relax
abd muscles.
26. I- Inspection
• 1- Shape (contour)
• Normal
• Sunken (Scaphoid): as in starvation,
malignancy.
• Distension
• Generalized: fat, fluid, flatus, feces,
fetus
• Localized: gross enlargement of an
organ, or mass.
32. Inspection
• 2- Umbilicus:
i. Shape: normally slightly retracted and inverted.
• Everted: as in umbilical hernia
• Deeper than normal: obesity
ii. Site
iii. Nodules: malignancy
iv. Pigmentation
35. Inspection (cont’)
• 3- Movement of the Abd. Wall
i. Movement with respiration: absent of
diminished with generalized peritonitis.
ii. Visible pulsations
iii. Visible peristalsis:
• pyloric obst,
• intestinal obstruction .
• May be normal in elderly with thin abd wall (no
history of pain)
36. Inspection (cont’)
• 4- Skin:
i. Smooth and shiny in marked distension.
ii. Striae:
• white or pink linear marks.
• Produced by gross stretching of the skin with
rupture of elastic fibers.
• Indicates recent change in the size of the
abdomen: preg, ascites, wasting diseases
• Wide purple striae are characteristic of cushing
and excessive steroid therapy
iii. Scars
39. Inspection
4- skin (cont’)
iv. Abnormal veins: dilated, tortuous. Check
direction of flow:
• Portal hypertension: veins are centrally placed
• IVC obstruction: on the sides of the abd.
v. Hair distribution.
vi. Pigmentation and rash.
41. Inspection
• 5- Divarication of Recti
• 6- Hernial orifices:
• Better while the patient is standing
• Ask him to cough
• Look for expansile impulse
47. II- Palpation
• 1- Superficial palpation:
• Pain & Tenderness.
• Rigidity
• Superficial swelling.
• 2- Deep Palpation
• Liver, Spleen, Kidney, GB
• Aorta and para-aortic glands
• The urinary bladder
• Rt & Lt lower quadrants.
• If a swelling is palpable, illicit its features
• Dipping method
48. Liver
• Palpate both Rt & Lt lobes
• Lt lobe is palpated in the middle line.
• Rt lobe is palpated in the Rt MCL lateral to
the rectus muscle.
• Different methods for palpation
• Both hands side by side with fingers pointing to the ribs
• Rt hand parallel to the costal margin
• Hooking method
• Comment on:
• Size: normal, enlarged, shrunken
• Edge: sharp, rounded
• Surface: smooth, nodular
• Consistency: soft, firm, hard.
• Tenderness.
52. Spleen
• Start from the Rt lower quadrant moving
toward Lt costal margin while asking the pat
to take deep breath.
• Lt hand is placed over the lowermost rib
cage posterolaterally.
• If not palpable; repeat while the pat is in the
Rt lateral position.
• Try to feel the notch on the medial border.
• In contrast to kidney swelling, you can’t get
above the upper pole of the swelling.
• Comment on the size, edge (sharp),
tenderness, consistency.
54. Kidney
• Felt bimanually
• Lt hand is placed in the renal angle
• Rt hand is placed anteriorly in the lumbar
region.
• Ask the pat to take deep breath in, press
Lt hand forwards and Rt hand backwards.
• The kidney is felt as a rounded firm
swelling between both hands (i.e.
bimanually palpable) and can be pushed
from one hand to the other.
57. Urinary Bladder
• Normally not palpable.
• If there is retention of urine:
• It is felt as smooth, firm, regular, oval-
shaped swelling in the suprapubic region.
• Its upper border may reach the umbilicus.
• Its lower border can‟t be felt (pelvi-
abdominal mass)
• In women, it has to be differentiated
from gravid uterus, fibroid, ovarian cyst
(usually eccentrically placed to Lt or Rt
side)
60. Dipping
• When there is large amount of
ascites, palpation of enlarged
viscera may be difficult.
• This method of palpation is
performed by a quick pressure
of the tips of the fingers over the
region where the edge of the
organ is expected.
61. Abdominal Mass
• 1- make sure that it is not a normal
structure:
• pelvic colon particularly when loaded
with stool, the caecum
• The caecum: soft, rounded swelling
• Lower pole of the Rt kidney
• 2-Next consider whether it could be due to
enlargement of intra-abd organs e.g liver,
spleen, kidney, GB..
62. Abdominal Mass
Comment on the following
• Site: extra or intra-abd., abd or pelvi-abd
• Size
• Shape
• Surface, edge, consistency
• Mobility and attachment
• Is it bimanually palpable? Renal
• Is it pulsatile? Transmitted or expansile
63. III- Percussion
• 1- To define the boundaries of abd
organs e.g upper and lower border of
the liver, spleen, urinary bladder.
• 2- Detection of ascites”
• Shifting dullness.
• Knee-elbow position
• Fluid thrill.
72. IV- Auscultation
• Minor role.
• Done before palpation and
percussion as touching the abdomen
may alter the abd sounds.
• Use the warm diaphragm, and listen for
15-20 sec.
73. • Examine for bowel sounds:
• Are bowel sounds present or absent?
• If present, are they frequent of sparse? Normal
frequency is variable: every 5-10 sec
• What is the quality of the sounds? Exaggerated
in intest obst.
• Succussion splash in pyloric obst
• Vascular sounds:
• Venous hum: in portal hypertension
• Systolic murmur: suggest narrowing of an
artery
• Friction Rub: peri-hepatitis, peri-splenitis.
