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1、腹部检查1Exam of the AbdomenThe importance of abdominal examinationThe specialities of abdominal examination1、Perform in order: inspection,auscultation,percussion ,palpation；Record in order: inspection, palpation, percussion, auscultation; 2、Palpation is of the highest importance； 3、Perform gently； 4、Pa
2、y attention to patients expression； 5、There are superficial palpation, deep palpation et al。Study methodLongitudinal：comprehensive: I, A,P,Pa thinking “the whole body” ideaTransverse: differential diagnosisspecial point thinking different itemsthe same purposee.g. Shifting dullnessfluid wave ascites
3、puddle testHow to perform all the itemsabnormal findingsclinical meaningSurface markings and regions of abdomen（anatomy basis）1、costal margin 2、xiphoid process 3、upper abdominal angle 4、umbilicus 5、anterior superior iliac spine 6、lateral border of reclus muscles（gallbladder point） 7、midabdominal lin
4、e 8、inguinal ligament 9、costo-vertebral angleA surface map of the abdomen used to describe the location of abnormalities two systems of mappingFour quadrants of the abdomenNine quadrants of the abdomenEpigastric regionUmbilicalregionHypogastric regionRight hypochondrial regionRight lumbar regionRigh
5、t iliacregionStrong point weak pointAbdomen anatomyAbdomen anatomySigmoid colon Left ovaryDescending colon Small bowel Left kidneySpleen Colon stomachStomach Duodenum Tr colon Aorta Pancreas liverLiver Gallbladder DuodenumAscending colon Right kidneyAppendix Caecum Right Ovary Small bowelBladder Ute
6、rus Small bowelPatients Position：supine position enough exposurecomfortable relaxedraise his head and shoulders a few inches and slightly flex his knees and hips. Approach from the right sideAbdominal examinationcontents：appearance(normal appearance)skin(superficial) veins breath movementgastric or
7、intestinal pattern and peristalsisinguinal areaherniaumbilicusthrobbing in the epigastric regionInspectionGlobal abdominal enlargement(distension)：fluid: ascites（abdominal circumference）air: in the stomach or intestine, pneumoperitoneumfat: obesityabdominal mass in large sizedifferentiate obesity fr
8、om ascites（frog belly）apical belly Local enlargement：inside or outsideposition; contour; breath; motility; throbbing; valsavaGlobal abdominal concauity：scaphoid abdomenAbdominal appearanceInspectionGlobal abdominal enlargement(A) obesity or gaseous distension: the umbilicus is inverted. (B) ascites:
9、 the umbilicus is everted. (C) The scaphoid (boat- shaped) configuration of slender people.(D) a lower abdominal mass, a distended bladder for example. (E) an upper abdominal mass, an enlarged liver, for example Skinskin eruption：herpes zoster Pigmentation and color：Cullen Sign, Grey-turner SignSpid
10、er Angiomata stria(e)： scar： hair：InspectionSpider Angiomata - dilated arterioles, most often visible on the skin of the upper chest Liver cirrhosismassive retroperitoneal bleeding (classically in severe acute pancreatitis): the blood dissects around the flanks between the fascial layers below the s
11、ubcutaneous fat to reach the subepidermal tissue on the anterior abdomen, either in the flanks (Grey-turner Sign) or about the umbilicus (Cullen Sign). Abdominal striae : the rupture of subepidermalconnective tissue abdominal distension reddish or pink; fades to white large doses of corticosteroids:
12、 remain pink until the dosageis reduced. Abdominal superficial veins：How to determine the direction of blood flow：指压法InspectionPortal hypertension Budd-Chiari syndrome指压法判断血流方向Breath movement：gastric or intestinal pattern and peristalsis: ObstructionDecrease or disappearance: peritonitis, ascites he
13、rnia:umbilicus:inguinal area:throbbing in the epigastric regionInspectionthrobbing in the epigastric regionRight ventricle: Increase with deep breathAorta: Decrease with deep breath The most common cause of a pulsative liver:tricuspid incompetence. Caput medusaeAuscultation bowel soundsBruits(murmur
14、)：position、time（murmurs of artery or vein）friction rubs： scratch test(搔刮试验)： puddle test(水坑试验)：Are bowel sounds present? If present, are they frequent or sparse (i.e.quantity)? What is the nature of the sounds (i.e. quality)? Hyperactive：intestinal infection, hemorrhage, laxativeHigh-pitched：mechani
15、cal ileus(loud bowel sounds accompany cramping abdominal pain or abdominal distension)Hypoactive：peritonitis、hypokalemia、hypomotilityThe absence of bowel sounds : peritonitisBowel Sounds The viscera near the diaphragm move with respiration and rub peritoneal surfaces together. When there is peritoni
16、tis in the upper abdomen without much exudate, the rubbing of the inflamed peritoneal surfaces produces a dry, soft, scraping sound heard early in the course of peritonitis. occurs in splenic infarction, in neoplastic disease that involvesthe surface of the liver, in abscess formation in either organ. -friction rub, a rare finding,Have the patient lie prone for 5 minute
