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GUIDE TO CLIN ICAL M EDI CIN E I: PRACTI CALS

Dok T - The Unr eliabl e Sourc es
ABDOMEN
MATERIALS
Stethoscope, wrist watch, tape measure
INTRODUCTION
Technique
Sample Report
Good morning, Im Dr ______. May I know
Introduction/Permission
your name? Im going to examine abdomen,
is that OK with you?
NONE. Hindi ito nirereport. Gawin mo lang
Proper position of patient - Supine
Pero if ever itanong sayo, ok na din na alam
mo. Memorize mo yung nasa Technique
column na info.
Draping and adequate exposure xiphoid
process to iliac crest
For draping, itataas mo ang drape to nipple
line pag liver span
Position of examiner right side of patient
For position of examiner, lilipat ka sa LEFT
side
only when doing MIDDLETONs method
Proper sequence of exam Inspection,
Auscultation, Palpation, Percussion, Special or SPLENIC HOOKING which is NOT required.
Pero baka lang i-side question.
Exams.
INSPECTION
Check size measure abdominal
Pag at the level of the abdomen ang tingin,
circumference at the level of the umbilicus dun mo malalaman yung contour. Wag isang
Shape, contour (flat, scaphoid, or
tinginan lang ok na, take your time.
protuberant)
Skin lesions, superficial veins, scars, striae,
Patients abdominal circumference is _____
and skin discoloration
inches at the level of the umbilicus. Abdomen
is flat, symmetrical, without abnormal
Umbilicus (inverted, flat, everted)
bulging or masses. There are no visible
scarring, lesions, superficial veins, striae or
Symmetry
discoloration upon inspection. Umbilicus is
inverted. No visible pulsations or peristalsis
Visible peristalsis, pulsations
noted.
AUSCULTATION
Start listening for bowel sounds at the RLQ.
Bowel sounds Normal is 5-34 per minute.
Memorize the info dun sa TECHNIQUE.
Use DIAPHRAGM.
Bruit 5 vessels abdominal aorta., left
and right renal artery, left and right iliac
artery. Normal = no sound

Bowel sound is ____ cycles per minute upon

auscultation. No bruit heard over abdominal
aortic vessel, right and left renal arteries and
right and left iliac arteries.

PALPATION
OBSERVE PROPER HAND PLACEMENT yun ang tinitignan dito
Light palpation tone and consistency of
abdominal wall, tenderness, superficial
mass.

Deep palpation of the liver

Parang hinihimas niyo lang siya ng madiin.

Bawat press, tanungin kung masakit..
Abdomen is soft with no tenderness or
rigidity. No superficial masses palpated.
1. Left hand under patient (right side)
2. Right hand below subcostal margin, fingers
facing HEAD of patient.
3. Ask patient to inhale, sabay tulak ng left
hand pataas.
4. Normal not palpable

Technique

Deep palpation of spleen

Deep palpation of kidney

Sample Report
1. Left hand under patient (left side)
2. Right hand below subcostal margin, fingers
facing your supporting (left) hand
3. Ask patient to inhale, sabay tulak ng left
hand pataas.
4. Normal not palpable
1. Left hand under patient, level of umbilicus
2. Right hand beside umbilicus
3. Normal not palpable

Palpation sample report: Abdomen is soft with no tenderness or rigidity. No superficial masses palpated. Liver,
spleen and kidney are not palpable
PERCUSSION
All quadrants for general tympanism

Liver span test for hepatomegaly

Traubes space test for splenomegaly

1. Adjust drape, to nipple line

2. Percuss from RMCL, slightly below
umbilicus. Pag nagshift to dullness, ibalik niyo
muna sa tympanitic portion to be sure
(parang double check kung nag dull nab a
talaga) if sure na, mark area. WARN THE
PATIENT, nagugulat sila pag bigla niyo sila
sinusulatan/tinutusok ng ballpen.
3. Percuss from slightly below nipple line,
RMCL. The same, idouble check kung nagdull
ba talaga. Mark
4. Measure using tape measure. Normal liver
span is 6 to 12 cm.
1. Boundaries: superior left 6th rib
Lateral left midaxillary line
Inferior left costal margin
2. Percuss normal is tympanitic. If dull =
splenomegaly

Percussion sample report: Abdomen exhibits general tympanism. Liver span is within normal limits at 9 cm.
Spleen dullness is absent at Traubes space.
SPECIAL TESTS

Murphys sign acute cholecystitis

Psoas sign acute appendicitis

1. Hooking technique. Use either left thumb

or right 4 lesser fingers.
2. Ask patient to take deep breath. During
EXHALATION push your fingers. Pag inhale
niya uli BOOM tatamaan na dapat ng
gallbladder niya ang fingers mo na
nakapasok.
3. Positive result inspiratory arrest. Kasi
masakit.
1. Flex the thigh while supine.
2. Positive sign pain at RLQ

Obturator sign acute appendicits

1. Internally rotate the thigh

2. Positive sign pain at RLQ

Markels sign jar tenderness test for

acute appendicitis

1. let patient stand on tiptoes tapos biglang

bagsak.
2. (+) result = pain

Technique

Sample Report

Rovsings sign test for acute appendicitis

1. press LLQ
2. (+) result pain at RLQ pag binitawan mo
na yung LLQ

Fluid wave - ascites

1. ask pt to put hand in middle of abdomen

2. 1 hand should be tapping, yung isa
pinapakiramdaman kung may fluid wave.
3. Normal wala dapat maramdaman.
(para malaman niyo kung ano pakiramdam
ng fluid wave, magtap kayo ng walang
kamay sa gitna ng abdomen =D)

Shifting dullness - ascites

1. pt is supine. Percuss from abdomen

palateral. Mark the area kung saan magiging
DULL ang sound.
2. pt in right side lying (facing you) percuss
from the top.
3. Positive pag nalipat yung dullness.

Costovertebral angle tenderness/kidney

punch test test for acute pyelonephritis

1. Place hands below 12th rib sa likod malapit

sa spine. (costovertebral angle)
2. Strike with ulnar side of other hand.
3. Repeat sa other side
4. Normal walang pain.

Special tests sample report (banggitin kung para saan yung special test na nirereport mo): Negative result for
Murphys sign, no acute cholecystitis. Negative results for Psoas, Obturator, Markels and Rovsings sign, no
acute appendicitis. Negative results for fluid wave and shifting dullness, no ascites. No costovertebral angle
tenderness, no acute pyelonephritis.