Abdo Clinical session 2.0

Question 1

draw all the nine quadrants for the abdomen.

Where does the transpyloric plane lie?

Answer 1

It lies midway between the superior border of the manubrium of sternum and pubic symphisis.

it lies at the level of L1 vertebral.

Question 2

Draw the 4 quadrants of the abdomen and state what lies in each quadrant.

Answer 2

right upper: liver, gall bladder, kidney

right lower: colon, small intestine

left upper: stomach, part of liver spleen, kidney

left lower : colon,

Question 3

What structure must you follow using the clinical exam

Answer 3

Inspection

Palpation

Percussion

Auscultation.

Question 4

why do some physicans perform auscultation before palpation or percussion?

Answer 4

Prevents bowel sounds being disrupted by deep palpation.

Question 5

what should you inspect for in the abdomen ?

Answer 5

• Shape of the abdomen
• Skin abnormalities
• Surgical scars
• Masses
• Hernias
• Movements of the abdominal wall with respiration,
• For any asymmetry .

Question 6

what shoud the umbilicus normally look like. Give any abnormalites and cause for it

Answer 6

NORMALLY inverted.

obesity- sunken

Umbilical hernia- distended and everted.

Question 7

give any abnormalities during inspection

Answer 7

• Abnormally large veins- portal hypertension/obstructed vena cava
• Abdominal swelling- could be due to ascites or intestinal obstruction.
• Asymetry- localised mass

Question 8

what are the 2 types of palpation of the abdomen? what do you look for during palpation. give details

Answer 8

light and deep palpation-

• look at patients face for pain/wincing.
• voluntary guarding of abdomen: when palpation cause pain and the abdomen contracts.
• Rigidity of the abdomen: inflammation of parietal peritoneum and abdominal wall undergo relfex contraction. No movement with respiration
• Rebound tenderness: sharp stabbing pain when hand is released during palpation (in localised/generalised peritonitis)

Question 9

What can you discern when you auscultate the abdomen

Answer 9

looking for bowel sounds.

• Absent bowel sounds (2 min)- paralytic ileus or peritonitis
• High pitched bowel sounds - intestinal obstruction.

You can listen for vascular bruits:- turbulent flow in artery by aneurysm/obstruction:

• Abdominal aorta– just above and left of the umbilicus
• Superior mesenteric or coeliac arteries – epigastrium
• Renal arteries - 2- 3 cm super and lateral to the umbilicus
• Liver tumours – over the liver
• Iliac arteries – in the iliac fossa

Question 10

How do you palpate the abdomen to ascertain the health of the liver

Answer 10

use your index finger first (along with other fingers) to palpate from right iliac fossa upwards each BREATH.

the liver shouldnt be palpable in healthy adults during inspiration (although it does move down a little). It is palpable in CHILDREN (0-16 yrs old).

if you palpate it in adult, look for the any tenderness or pulsations. ascertain its surface

Palpable liver in adult is due to hepatomegaly and could be as a result of:

• congestive heart failure
• hepatitis
• tumours
• cirrhosis

Question 11

what does gallbladder pain signify and describe how you would ascertain it?

Answer 11

Could be gallstones (choleithiasis) or cholecystitis.

Usually referres in EPIGASTRIC region. and later on it goes down to right hypochrondium as it involves the underlying parietal peritonieum.

Can elicit this using Murphys’s sign. Tell the patient to inspire and palpate the right subcostal area. There will be pain.

Question 12

how do you palpate the spleen and what can you ascertain from it.

Answer 12

Same way as liver go ACROSS from right iliac fossa to left hypochondrium.

In splenomegaly- spleen can be palpated in umbilicus upwards (grown 3-4 times and becomes paplable below the left costal margin)

Question 13

draw the surface projections of liver and gallbladder.

Give details

Answer 13

Question 14

what are the 3 borders of the liver

Answer 14

upper, oblique and lower borders.

Question 15

draw the surface projection of the spleen

Answer 15

posterior between ribs 9, 10 and 11.

in between mid axillary line and latreal border of erector spinal muscles

Question 16

where do you percuss the liver

Answer 16

start from right iliac fossa (resonant sound) and perucss upwards towards right costal margin where it becomes dull.

You can also stratf from 4th or 5th ribs at MCL and percuss downwards until right costal margin. length of liver vertically is 13 cm

Question 17

where do you percuss for the spleen

Answer 17

ALONG with the line the lower most intercostal space is the 10th and 11th ribs.

Positive sign for splenomegaly that doesn’t extend beyond the costal margin! - percussion note becomes dull on full inspiration