PEMERIKSAAN ABDOMEN

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PEMERIKSAAN ABDOMEN

• PSIK
• FIKES UMM

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General Considerations

• The patient should have an empty bladder.
• The patient should be lying supine on the exam
  table and appropriately draped.
• The examination room must be quiet to perform
  adequate auscultation and percussion.
• Watch the patient's face for signs of discomfort
  during the examination.
• Use the appropriate terminology to locate your
  findings
• Disorders in the chest will often manifest with
  abdominal symptoms. It is always wise to examine
  the chest when evaluating an abdominal complaint.
  
• Consider the inguinal/rectal examination in
  males. Consider the pelvic/rectal examination in
  females.
• EXAM SECTIONS
• Inspection
• Auscultation
• Percussion
• Palpation

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1. INSPECTION

• Physicians locate findings in the abdomen in one
  of four quadrants or one of nine regions.
• The four quadrants are
• right upper (RUQ),
• right lower (RLQ),
• left upper (LUQ) and
• left lower (LLQ).
• THE NINE REGIONS
• epigastric,
• umbilical,
• hypogastric/suprapubic,
• right hypochondriac,
• left hypochondriac,
• right lumbar,
• left lumbar,
• right inguinal and
• left inguinal.

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LOCATIONS of ABDOMINAL ORGANS

• The schematic below is a reminder of what organs
  are likely to produce findings in each region.
• For example
• Right hypochondriac (RUQ) liver and gall
  bladder
• left hypochondriac (LUQ) the spleen and stomach
  
• epigastric the pancreas, stomach and common
  bile duct
• umbilical the small intestine
• lumbar the kidneys
• iliac regions the ovaries
• left iliac/LLQ the sigmoid colon
• right iliac or lumbar (RLQ) the cecum and
  appendix
• suprapubic the bladder and uterus

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• SOME COMMON FINDINGS on ABDOMINAL INSPECTION
• Scars Jaringan parut
• Striae (stretch marks) tanda peregangan? ibu
  hamil
• Colors - Bluish color at the umbilicus is
  Cullen's sign a sign of bleeding in the
  peritoneum.
• - Bruises on the flanks are Grey Turner's sign
  (retroperitoneal bleeding - e.g. from inflamed
  pancreas)
• Jaundice warna kuning pada kulit
• Prominent veins may be due to portal vein
  obstruction or inferior vena cava obstruction

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ABDOMINAL DISTENSION

• Distension of the lower abdomen only can be
  caused by pregnancy, full bladder, ovarian tumor,
  or uterine fibroids (common benign growths)
• Diffuse abdominal distension can be caused by any
  of the 6 Fs
• Fat (obesity)
• Fluid (ascites - peritoneal fluid - or obstructed
  viscera filled with fluid)
• Flatus (air) - e.g. from air swallowing or
  intestinal obstruction
• Feces (constipation
• Fetus (pregnancy)
• Fatal cancer.

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2. AUSCULTATION

• GUT SOUNDS
• Use the diaphragm of your stethoscope to listen
  to gut sounds
• Normal gut sounds are   gurgling, 5 to 35 per
  minute
• Borborygmi are loud, easily audible sounds. They
  are normal, too.
• High pitched , tinkling (raindrops in a barrel)
  sounds are a sign of early intestinal obstruction
  
• Decreased sounds (none for a minute) are a sign
  of decreased gut activity. Gut sounds may be
  markedly decreased after abdominal surgery
  abdominal infection (peritonitis) or injury.
• Absent Sounds   (no sounds for 5 minutes) are a
  bad sign. They can be caused by longer-lasting
  intestinal obstruction, intestinal perforation or
  intestinal (mesenteric) ischemia or infarction

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3. PERCUSSION

• What it finds liver size (kind of), spleen,
  fluid.
• Percussing the body gives one of three notes
• Tympany is found in most of the abdomen, caused
  by air in the gut. It has a   higher pitch than
  the lung.
• Resonance is found in normal lung. It is lower
  pitched and hollow.
• Dullness is a flat sound, without echoes. The
  liver and spleen, and fluid in the peritoneum
  (ascites ah-SY-teez), give a dull note.

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• A. Liver Span
• Percuss downward from the chest in the right
  midclavicular line until you detect the top edge
  of liver dullness.
• Percuss upward from the abdomen in the same line
  until you detect the bottom edge of liver
  dullness.
• Measure the liver span between these two points.
  This measurement should be 6-12 cm in a normal
  adult.
• B. Splenic Dullness
• Percuss the lowest costal interspace in the left
  anterior axillary line. This area is normally
  tympanitic.
• Ask the patient to take a deep breath and percuss
  this area again. Dullness in this area is a sign
  of splenic enlargement.

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• Shifting Dullness
• This is a test for peritoneal fluid (ascites).
• Percuss the patient's abdomen to outline areas of
  dullness and tympany.
• Have the patient roll away from you.
• Percuss and again outline areas of dullness and
  tympany. If the dullness has shifted to areas of
  prior tympany, the patient may have excess
  peritoneal fluid.
• Psoas Sign
• This is a test for appendicitis.
• Place your hand above the patient's right knee.
• Ask the patient to flex the right hip against
  resistance.
• Increased abdominal pain indicates a positive
  psoas sign.
• Obturator Sign
• This is a test for appendicitis.
• Raise the patient's right leg with the knee
  flexed.
• Rotate the leg internally at the hip.
• Increased abdominal pain indicates a positive
  obturator sign.

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4. PALPATION

• General Palpation
• Begin with light palpation. At this point you are
  mostly looking for areas of tenderness. The most
  sensitive indicator of tenderness is the
  patient's facial expression (so watch the
  patient's face, not your hands). Voluntary or
  involuntary guarding may also be present.
• Proceed to deep palpation after surveying the
  abdomen lightly. Try to identify abdominal masses
  or areas of deep tenderness

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Palpation of the Liver

• Standard Method
• Place your fingers just below the right costal
  margin and press firmly.
• Ask the patient to take a deep breath.
• You may feel the edge of the liver press against
  your fingers. Or it may slide under your hand as
  the patient exhales. A normal liver is not
  tender.
• Alternate Method
• This method is useful when the patient is obese
  or when the examiner is small compared to the
  patient.
• Stand by the patient's chest.
• "Hook" your fingers just below the costal margin
  and press firmly.
• Ask the patient to take a deep breath.
• You may feel the edge of the liver press against
  your fingers.