Examination of the abdomen

Prof. dr D.Bokonjić
By PresenterMedia.com
QUADRANTS
Abdominal Level
Abdominal Quadrants on Specific level

I Epigastrium: Right Hypochondrium,

Epigastric Left Hypochondrium
II Mesogastrium: Right Lumbar, Left
Umbilical Lumbar
III Hypogastrium: Right Iliac,
Suprapubic/Hypogastric, Left Iliac
Techniques of physical
examination
During the examination, the child should lie
with the legs bent at the knees, the arms
should be stretched out next to the trunk or
crossed over the chest.
Examination of the abdomen includes:
I. Inspection
II. Palpation
III. Percussion
IV. Auscultation
INSPECTION
Abdominal indentation in: thin-asthenic persons
Abdominal protrusion in: obese (fatty tissue), meteorism-
flatulence (due to the filling of the intestines with gases,
serpentine movements of the intestines and gurgling
also occur), paralytic ileus (due to paralysis of the
intestines, flatulence without movement and noises,
enlargement of the spleen
Skin-measles, scars,
Abdominal symmetry
Respiratory movements of the abdomen-increased (in
lung and pleural diseases)
Presence of hernia (hernia)
PALPATION

Palpation can be:

Superficial - performed by light pressure on
the abdominal wall-identification of all
superficial organs or tumors,
for palpation of painful (sensitive) areas of
the abdomen,
assessment of abdominal musculature
rigidity (defense, e.g. in case of peritonitis)
Deep - is performed by applying stronger
pressure on the abdominal wall- determining
the position and size of the abdominal
organsof the tumor
PALPATION OF LIVER
a. Both hands - start below the navel and up; we press with
our hands and the patient
breathes in (pressure - patient's breath) - we feel the
impact of the liver on the fingers
b. Spoon technique - the right hand bent slightly in the
fingers goes upwards, and we place
the hand on the abdomen sideways (where the little finger
is), with the direction of the hand parallel to the rib cage,
the same pressure is applied - the patient's breath
c. Hand technique "inverted" - both hands under the right
rib cage and inhale, with the doctor facing the opposite of
the patient's face
d. Friction (auscultatory) method - the earpiece is placed in
the epigastric corner and the nails are scratched on the
skin going from the mesogastrium to the right
hypochondrium. The place where the murmur becomes
PALPATION OF SPLEEN
The spleen is not normally palpable. The spleen lies under the
dome of the left hemidiaphragm, behind the middle axillary
line, between the 9th and 11th ribs.
 With the left hand, the left hypochondrium is raised from
behind, and with the right hand, at a right angle to the left rib
cage, we go up, the patient then takes a deep breath
- The spleen can also be palpated in a left decubitus when we
do not lift the left hypochondrium with the left hand, but
palpate the spleen with the right hand which falls down under
the influence of gravity so that it is palpable if it is
Enlarged.
 Stomach and gallbladder
Stomach-:
a. On palpation in the epigastrium, there is sensitivity (pain) in case of
pyloric ulcer or duodenal bulb. Obrascov's point is located under the
xiphoid process, one finger to the right of the left medioclavicular line.
When the ulcer is perforated, the epigastrium is as hard as a board
(defans).
b. Bursting phenomenon - in pyloric stenosis and an atonic stomach can
be caused by tapping the fingers or perigastric palpation.
5. Gallbladder - is normally not palpated, but an enlarged one is
palpated.
a. Murphy's sign-pain sensitivity the size of two thumbs at the place
where the rectus muscle crosses the medioclavicular line, during
palpation the patient takes a breath,
b. Courvoisier's sign - enlarged, tense, painless gallbladder + icterus
KIDNEYS
Kidneys - located retroperitoneally, right kidney between
vertebrae Th 12 and 13, and left kidney between vertebrae
Th11-L2
Kidneys are not normally palpable!!!
The technique used for palpation is called bimanual contact
for: Right kidney-the doctor places his left hand behind the
patient parallel to the ribs, and places his right hand in the
upper right quadrant. We tell the patient to breathe, and then
to stop breathing for a short time, we slowly release the right
hand and feel how the kidney then returns to its previous
position.
Fist percussion of the lumbar areas (veterinary percussion) -
the painful sensitivity of the kidneys in the costovertebral
angles is examined; it is performed in a standing position
APENDICITIS
a. McBarney's point-in the middle of the line joining the
umbilicus and the right spina iliacu anterior superior (its
tenderness on palpation)
b. Chain point-joint of the outer third and middle third of
the bispinal line on the right side
c. Rovsing's sign - deeply palpate the left iliac region and
then suddenly release, then pain occurs in the right iliac
region.
d. Blumberg's sign - deep palpation of the right iliac
region, then suddenly let go. Pain occurs
in the right iliac region - subsequent sensitivity test.
e. Psoas sign - the doctor places the right hand on the
thigh above the knee, tells the patient to raise the leg
against resistance, pain will occur due to irritation of the
psoas muscle by an inflamed appendix
PERCUSSION
Percussion - a normal percussion sound is
tympanic over the intestines, and dull over
compact organs (liver, spleen, etc.)
It is used to determine:
The border of the liver - it is percussed on:
the lower border of the liver - in the right
medioclavicular percussion, start below the
level of the navel and then slightly up the
upper border of the liver-darkness: by
percussing from the area of ​pulmonary
sonority (resonance) down
along the linei mediosternalis
PERCUSSION
The spleen lies under the dome of the left diaphragm behind the mid-
axillary line. Percussion first in the direction of the middle axillary line,
and then in a star pattern from all directions, is performed in case of
suspicion of splenomegaly.
Ascites - to prove its presence, the following examinations are performed:
Percussion - starts in the epigastrium and percusses in a fan-like manner
towards the lower and lateral parts of the abdomen. The line of the
ascites level (darkness) is arc-shaped.
Test of moving the darkness position - when moving the patient from one
side to the other (left-right), the border of darkness moves in accordance
with gravity.
Fluctuation test (water wave) - put the fist of the left hand on the side of
the right side, and the other hand
the hand hits the opposite side (left side), which causes the liquid to
move and hits the abdominal wall (right side), which we feel as a wave.
AUSCULTATION
It serves to assess intestinal motility
(peristalsis), detection of vascular murmurs,
ascites, etc.
By auscultation, we listen to:
A. Peristalsis (motility) of the intestines, which
can be:
1. Normal - you can hear gurgling that occurs
as a result of the flow of liquid and air in the
intestines during peristaltic movements
2. Increased in: mechanical ileus, diarrhea
(acute enterocolitis), starvation
3. Extinguished in: paralytic ileus, peritonitis
NORMAL FINDING
Normal findings:
1. Abdomen in line with the chest, no skin
changes
2. Soft, insensitive to superficial and deep
palpation
3. Liver and spleen are not palpable
4. Lumbar lobes insensitive to rough
percussion, percussion sound tympanic
5. Auscultatory findings abdomen: peristalsis
preserved without vascular murmurs