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  • Inspection: James Wight

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    ghinsavit
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    The document provides guidance on performing a physical examination of the abdomen. It describes the steps to inspect, palpate, percuss, and auscultate the abdomen, including examining specific organs and areas. Clinical findings that may be observed during the exam and their potential significance are also defined.

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    19824 Clinical sklls

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    19824

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    The document provides guidance on performing a physical examination of the abdomen. It describes the steps to inspect, palpate, percuss, and auscultate the abdomen, including examining specific organs and areas. Clinical findings that may be observed during the exam and their potential significance are also defined.

    Drepturi de autor:

    Attribution Non-Commercial (BY-NC)
    Descărcați ca PDF, TXT sau citiți online pe Scribd
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    33 vizualizări2 pagini

    Inspection: James Wight

    Încărcat de

    ghinsavit
    The document provides guidance on performing a physical examination of the abdomen. It describes the steps to inspect, palpate, percuss, and auscultate the abdomen, including examining specific organs and areas. Clinical findings that may be observed during the exam and their potential significance are also defined.

    Drepturi de autor:

    Attribution Non-Commercial (BY-NC)
    Descărcați ca PDF, TXT sau citiți online pe Scribd
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    din 2

    JamesWight

    ExaminationoftheAbdomen Washyourhands. Introduceyourselftothepatient,andaskpermissiontoexaminethem. Exposethepatient,andliethemflat.

    Inspection
    Lookaroundthebed Lookatthepatient Oxygen mask/nasal prongs, drips, cigarettes, specialfoods,diabeticdiet Comfortable at rest, wound drain, catheter, NG tube, jaundice, scratch marks, spider naevi, gynaecomastia, striae, bruising, anaemia, pigmentation, cachexia, dehydration, abdominal distension, abdominal masses, scars (rooftop, L shape, MercedesBenz, subcostal, midline, Lanz, Hockeystick, inguinal), Sister Mary Joseph Nodule, GreyTurners/Cullens sign, stomas, acanthosisnigricans,tattoos Clubbing (cirrhosis, lymphoma, IBD, Coeliac disease), leukonychia (hypoalbuminaemia), koilonychias (iron deficiency), palmar erythema, Dupuytrens contracture, anaemia, tendon xanthomata,liverflap Jaundice, anaemia, KayserFleischer rings, xanthelasma Ulcers, pigmentation, telangiectasia, fetor hepaticus, Candida, angular stomatitis, gums, smooth tongue, leukoplakia, atrophic glossitis, macroglossia

    Lookatthehands

    Lookattheeyes Lookinthemouth

    Palpation
    Feeltheneck Supraclavicular Virchowsnode lymph nodes, particularly

    Inspecttheabdomenagain,includingaskingthepatienttoraisetheirheadorlegs Lightpalpation Deeppalpation Feelfortheliver Feelforthespleen Ballotthekidneys FeelforaAAA In all 9 segments of the abdomen (ask if theres anypainfirst,andwatchthepatientsface) In all 9 segments of the abdomen, watching the face Startingin therightiliac fossa, askingthe patient tobreatheineachtimeyoupalpate Startingin therightiliac fossa, askingthe patient tobreatheineachtimeyoupalpate Putonehandposteriorlyintheflank,andflickthe kidneyontoahandpositionedanteriorly Abovetheumbilicus(theaortadividesbelowthis

    point)

    Percussion
    Percusstheliver Percussthespleen Checkforshiftingdullness Startingintherightiliacfossauntildull,then percussouttheupperborder Startingintherightiliacfossa With finger in the midline, move down the flankuntilpercussionnotebecomesdull.Ask thepatienttorollawayfromyouascitesis suggestedifthenotebecomesresonant. Ask patient to position their hand in the midline, and flick the abdomen to test for transmittedthrill

    Checkforfluidthrill

    Auscultation
    Listenforbowelsounds Listenforbruits Up to three minutes. Can be normal, absent ortinkling(inobstruction) Aortic,renal,iliac,femoral

    Finalmanoeuvres
    Examinetheanklesforoedema Examine the hernial orifices (or say you would,asbelow)

    Iwouldcompletemyexaminationby.
    I would like to examine the hernial orifices, examine the genitalia, perform a digital rectal examination,dipsticktheurineandlookattheobservationchart(temperature,BP,sats)

    Glossary
    Spidernaevitelangiectasiawithacentralarteriolefromwhichradiatenumeroussmallvessels.Foundinthe distributionoftheSVC,andduetohyperoestrogenicstateinliverfailure. Leukonychiawhiteningofthenailsduetohypoalbuminaemia Koilonychiaspoonshapednailsduetoirondeficiency Dupuytrenscontracturethickeningofthepalmarfascia,seeninrelationtoexcessalcoholintake,DM, epilepsyandhereditary. SisterMaryJosephnoduleumbilicalnoduleduetometastaticcancer GreyTurners/Cullenssignsflank/periumbilicalbruisingseeninpancreatitis KayserFleischerringsgreenbrownringsseenintheirisinWilsonsdisease Fetorhepaticusamustysweetsmellfoundinliverfailure Angularstomatitiscracksseenatthecornerofthemouth,seeninirondeficiency Leukoplakiawhitetongue:smoke,spirits,sepsis,syphilis,soreteeth Atrophicglossitisasmoothtongue,seeninvitB12andfolatedeficiency(amongstotherthings) Acanthosisnigricansvelvetypigmentedplaquesintheaxillaandbackoftheneck,seeninGImalignancy (andseveralotherconditions)

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