Examen físico de abdomen COMPLETO | Semiología | FCM UNR

Summary

This script offers a detailed guide on abdominal examination techniques, starting with the inspection of the abdomen's appearance and symmetry. It covers the division into nine quadrants and the identification of organs within. The examination includes dynamic and static inspection, auscultation for bowel sounds, and percussion to assess organ size and presence of fluid. Special attention is given to palpation methods for organs like the liver and spleen, and signs of conditions such as ascites and abdominal aortic pulsation are discussed. The script also addresses special situations like abdominal defense and tender points indicative of underlying issues.

Takeaways

• 🔍 The abdominal physical examination starts with inspection, followed by auscultation and palpation, with the abdomen divided into nine quadrants for better organ location.
• 📏 Key anatomical lines are used to divide the abdomen into quadrants: two vertical lines along the mid-clavicle and two horizontal lines at the costal margin and the anterior iliac spine.
• 👀 Inspection of the abdomen includes both static and dynamic observation, focusing on the shape, size, and characteristics of the abdomen, as well as its relationship with breathing and effort.
• 🌐 The abdomen is normally symmetrical, and any asymmetry can be a sign of underlying conditions.
• 🍂 Distribution of body hair and the presence of the linea alba and the navel are important to note, as deviations can indicate certain pathologies.
• 🔊 Auscultation is performed to listen for bowel sounds, which can be increased in inflammatory processes or decreased in ileus.
• 👂 Percussion of the abdomen helps to identify the presence of air or fluid interfaces and can be altered in conditions like pleural effusions or hepatomegaly.
• 👋 Palpation techniques vary, including monomanual and bimanual methods, and are used to identify tenderness, masses, or organomegaly.
• 🤲 Specific maneuvers are used to palpate organs like the liver and spleen, taking into account their respiratory mobility and potential for enlargement.
• 🚑 Special situations such as abdominal defense and rigidity, tender points, and ascites require specific examination techniques to diagnose conditions like appendicitis or aneurysms.
• 💡 The script emphasizes the importance of a thorough and systematic approach to abdominal examination to identify signs of various pathologies.

Q & A

What is the initial step in a physical examination of the abdomen?

The initial step in a physical examination of the abdomen is the inspection, which includes both static and dynamic observation of the abdomen's form, dimensions, and characteristics.

How is the abdomen divided for the purpose of examination?

The abdomen is divided into nine quadrants by drawing two vertical lines down the middle of the clavicle and two horizontal lines, one along the costal margin and the other at the iliac crest.

What are the two types of inspection mentioned in the script and what do they focus on?

The two types of inspection are static and dynamic. Static inspection focuses on the form, dimensions, and characteristics of the abdomen, while dynamic inspection is concerned with the relationship of the abdomen with respiration and efforts.

What is the significance of the umbilicus in abdominal examination?

The umbilicus, or navel, is important as it can be inverted in certain pathologies and is a central point of reference for the abdomen.

What is the normal range of hydroaeric sounds heard per minute during auscultation of the abdomen?

Normally, there are between 5 and 30 hydroaeric sounds per minute, which are sounds produced by the movement of the bowel contents with peristalsis.

How is the liver size estimated during abdominal examination?

The size of the liver can be estimated by percussion of the upper border and palpation of the lower border, with a normal length usually being about 10 to 12 cm.

What is the significance of the linea alba and what is its relevance to the abdomen?

The linea alba is a fibrous structure in the middle of the abdomen that can be important in certain pathologies and serves as a central reference line for the abdomen.

What is the difference between palpation for defense and palpation for rigidity in the abdomen?

Palpation for defense is a voluntary contraction of the abdominal muscles by the patient when experiencing pain, while rigidity is an involuntary condition that can be localized or generalized and is often associated with severe conditions like perforation of hollow viscera.

What is the significance of Murphy's sign in the script and what does it indicate?

Murphy's sign is a diagnostic maneuver used to detect inflammation of the gallbladder. If pressing on the specific point causes the patient to stop breathing due to pain, it is considered positive for gallbladder issues.

What is the purpose of the 'punch percussion' mentioned in the script?

Punch percussion is a diagnostic technique used to detect pain in the kidneys, which can indicate an infection or other renal issues. A positive result is indicated by the patient flinching or showing discomfort when the punch is applied.

How can the presence of ascites be identified during the abdominal examination?

Ascites can be identified by the presence of shifting dullness and fluid wave sign. The liver may also appear to be 'floating', and in cases of hepatomegaly with ascites, the liver may 'bounce back' when pressure is applied and released.