PEMERIKSAAN KLINIK

TUMOR INTRAABDOMEN
dr. Prapanca Nugraha, dr. Putri Julia Sari, dr. Rahmayeni Effendi, dr.
Samuel A. S. Kesek,
dr. Aulia Novariza, dr. Kurniadi Yusuf
MASSA INTRAABDOMEN

 Kategori massa intraabdomen

 Fisiologis : Kehamilan
 Inflamasi : Divertikulitis
 Vaskular : Aneurisma aorta abdominalis
 Neoplastik : Karsinoma kolon
 Obstruktif : Distensi buli atau dilatasi loop usus
TIPS FOR ENHANCING EXAMINATION OF
THE ABDOMEN
 Check that the patient has an empty bladder
 Make the patient comfortable in the supine position  slide your hand
under the low back to make sure the patient relaxed and lying flat
 Ask the patient to keep the arms at the sides or folded across the chest
 Move the gown to below nipple line and the drape to the level of the
symphysis pubis
TIPS FOR ENHANCING EXAMINATION OF
THE ABDOMEN
 Before begin the palpation, ask the patient to point to any areas of pain so
you can examine these areas last
 Warm your hand and stethoscope
 Approach the patient calmly and avoid quick unexpected movement and
also avoid long fingernails
 Distract the patient if necessary with conversation if patient is frightened
ABDOMEN
INSPECTION

Stand at the right side of the bed and inspect the abdomen (surface,
contour and movement):
 Skin ( scars, striae, dilated veins and rashes lesions)
 Umbilicus (observe its contour and location, inflammation or bulges
suggesting a hernia
INSPECTION

 Contour of the abdomen (flat, rounded, protuberant, scaphoid

marked concave or hollowed, any local bulges in inguinal or femoral,
symmetric, visible organ or masses)
 Peristalsis (observer for several minute if suspect intestinal
obstruction and it also visible in very thin people)
 Pulsations (normal aortic pulsation is frequentli visible in the
epigastrium)
INSPECTION
 Massa yang tampak saat inspeksi biasanya berkaitan dengan organ yang
berada pada area tersebut.
 RUQ :
 Hepatomegali : hepatitis atau tumor hepar, distensi kandung empedu
akibat kolesistitis atau kanker pancreas, atau carcinoma kaput
pankreas
 Epigastrium : distensi akut gaster, pseudocyst pancreas, kanker
pankreas, atau aneurisma aorta abdominalis
 Area subcostal kiri : biasanya disebabkan oleh splenomegaly.
Kemungkinan yang lain adalah karsinoma splenic flexure kolon.
INSPECTION

 Area lumbar : biasanya berasal dari renal, bisa berupa kista renal, ginjal
polikistik, dan keganasan ginjal.
 Lower quadrants : Bisa karena kelainan neoplastic atau inflamasi
intestine
 RLQ : Abses apendiks dan karsinoma caecum
 LLQ : Abses diverticular atau karsinoma sigmoid
 Hipogastrik : Kelainan pelvis
 Pria : Retensi urin akut
 Wanita : Neoplasma uterus atau ovarium
AUSCULTATION

 Provide important information about bowel motility

 Listen to the abdomen before performing percussion or palpation
because this manuevers may alter the frequency of bowel sounds
 Place the diaphragm of your stethoscope on the abdomen, listen for
bowel sound and note their frequency and character (5-34 per minute)
 Listen over the liver and spleen for friction rubs ( liver tumor,
gonococcal infection, splenic infarction)
PERCUSSION

 Help to asses the amount and distribution of gas in the abdomen and to
identify possible masses that are solid or fluid filled
 Percuss lightly in all four quadrants to assess the distribution of tympany
and dullness :
Note any dull areas that indicate mass or enlarged organ
On each side of a protuberant abdomen, note where tympany changes
to the dullness
PALPATION

 Light palpation
 Identifying abdominal tenderness, muscular resistance and superficial
organs and masses
 It serves reassure and relax the patient
 Keeping hand and forearm on a horizontal plane with finger together
and flat on the abdominal surface
 When moving your hand from place to place, raise it just off the skin,
moving smoothly in all quadrants
PALPATION

 If resistance is present, try to distinguish voluntary guarding from

involuntary muscular spasm with :
 feel for the relaxation of abdominal muscles that normally
accompanies exhalation
 ask the patient to mouth-breathe with the jaw dropped open
PALPATION

 Deep palpation
 Required to delineate abdominal masses
 Identify any masses and note their location, size, shape, consistency,
tenderness, pulsations and mobility (If resistance is present, try to
distinguish voluntary guarding from involuntary muscular spasm with :
 feel for the relaxation of abdominal muscles that normally
accompanies exhalation
 ask the patient to mouth-breathe with the jaw dropped open
(Permukaan : smooth, irregular, atau nodular)
PALPATION

 Bedakan massa ada di intraabdomen atau dinding abdomen : Minta pasien

untuk mengontraksikan otot abdomen
 Massa dinding abdomen : tetap teraba
 Massa intraabdomen : tertutup oleh kontraksi otot
REFERENSI

 Ferguson CM. Inspection, Auscultation, Palpation, and Percussion of the

Abdomen. Dalam : Walker HK, Hall WD, Hurst JW, editor. Clinical Methods : The
History, Physical, and Laboratory Examinations. Edisi 3. Boston : Butterworths;
1990.
 Bickley LS, Szilagyi PG. Chapter 9 : The Abdomen. Dalam : Bickley LS, Szilagyi PG.
Bates' Guide to Physical Examination and History Taking. Edisi 9. Philadelphia :
Lippincott Williams & Wilkins; 2007.
 Medscape. Abdominal Examination [document on the Internet]. New York : State
University of New York Downstate College of Medicine
TERIMA KASIH