006 The Abdomen - Introduction to Clinical Surgery Lectures

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Information about 006 The Abdomen - Introduction to Clinical Surgery Lectures

Published on July 1, 2008

Author: memorablemedicine

Source: slideshare.net

Description

Lecture on the abdomen from a series of lectures on an introduction to clinical surgery. It has been devised with medical students in mind.

The Abdomen Nick Harvey

The Abdomen: History Appetite Loss of weight How much? How quickly? Dysphagia Solids, fluids Heartburn Vomiting How often? Nature? Relation to eating? Certain time? Bile stained? Blood stained (haematemesis)?

Appetite

Loss of weight

How much? How quickly?

Dysphagia

Solids, fluids

Heartburn

Vomiting

How often? Nature? Relation to eating? Certain time? Bile stained? Blood stained (haematemesis)?

The Abdomen: History Indigestion Abdominal pain Abdominal distension Bowel habit Change Colour Consistency PR blood Bright or dark red Pan or paper Mixed or coating PR Mucous

Indigestion

Abdominal pain

Abdominal distension

Bowel habit

Change

Colour

Consistency

PR blood

Bright or dark red

Pan or paper

Mixed or coating

PR Mucous

The Abdomen: History Melaena Jaundice Itching Colour or urine/stools Fever Relation to symptoms

Melaena

Jaundice

Itching

Colour or urine/stools

Fever

Relation to symptoms

The Abdomen: General Examination Hands Nails, Palms, Pulse Eyes Conjunctiva, sclera, cornea Virchow’s node Chest Gynaecomastia, spider naevi, excoriation marks

Hands

Nails, Palms, Pulse

Eyes

Conjunctiva, sclera, cornea

Virchow’s node

Chest

Gynaecomastia, spider naevi, excoriation marks

The Abdomen: Local Examination Position Supine Exposure “Nipples to knees”

Position

Supine

Exposure

“Nipples to knees”

The Abdomen: The Regions

The Abdomen: Inspection Shape Size Scars (remember flanks & groins) Skin lesions Stoma Dilated veins Pulsations Hernias (remember groins) Divarication

Shape

Size

Scars (remember flanks & groins)

Skin lesions

Stoma

Dilated veins

Pulsations

Hernias (remember groins)

Divarication

The Abdomen: Palpation Superficial For tenderness & rigidity Deep For masses Organs Liver Spleen Kidneys Aorta

Superficial

For tenderness & rigidity

Deep

For masses

Organs

Liver

Spleen

Kidneys

Aorta

The Abdomen: Signs of Hepatomegaly Descends from below the right costal margin and costal angle You cannot get above it Moves with respiration Edge (sharp or rounded) Surface (smooth or irregular) Dull to percussion to the 8 th rib in the mid-axillary line

Descends from below the right costal margin and costal angle

You cannot get above it

Moves with respiration

Edge (sharp or rounded)

Surface (smooth or irregular)

Dull to percussion to the 8 th rib in the mid-axillary line

The Abdomen: Signs of Enlarged Gallbladder Appears from beneath the tip of the right 9 th rib Smooth and hemi-ovoid Moves with respiration No space between the lump and the liver Dull to percussion

Appears from beneath the tip of the right 9 th rib

Smooth and hemi-ovoid

Moves with respiration

No space between the lump and the liver

Dull to percussion

The Abdomen: Signs of Splenomegaly Appears from below the left 10 th rib and enlarges alongside this rib towards the umbilicus Firm with smooth surface and rounded edge Notch Can’t get above it Dull to percussion Can’t be balloted

Appears from below the left 10 th rib and enlarges alongside this rib towards the umbilicus

Firm with smooth surface and rounded edge

Notch

Can’t get above it

Dull to percussion

Can’t be balloted

The Abdomen: Signs of Enlarged Kidney Lies in the loins Moves with respiration Can be balloted Resonant to percussion (covered by colon)

Lies in the loins

Moves with respiration

Can be balloted

Resonant to percussion (covered by colon)

The Abdomen: Signs of a AAA Above the umbilicus Expansile Estimate size If pulsation below - iliacs

Above the umbilicus

Expansile

Estimate size

If pulsation below - iliacs

The Abdomen: Percussion & Auscultation Percussion Masses Fluid Auscultation Bowel sounds Vascular bruit

Percussion

Masses

Fluid

Auscultation

Bowel sounds

Vascular bruit

The Abdomen: Don’t forget to examine Back External genetalia DRE Urine dip & β HCG

Back

External genetalia

DRE

Urine dip & β HCG

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