Pemeriksaan Fisik Abdomen

Summary

This video script demonstrates a detailed physical examination of the abdomen, covering inspection, auscultation, percussion, and palpation techniques. The process includes assessing the abdominal wall for symmetry, checking for signs of peritonitis or venous distention, and performing auscultation to evaluate intestinal sounds. Percussion is used to check for liver size, fluid accumulation (ascites), and potential organ enlargement, while palpation helps detect abnormalities such as tumors, or enlargement of the liver, spleen, or kidneys. The examination concludes with checking for pain or abnormal findings in the kidneys, ensuring a thorough assessment of the patient's abdominal health.

Takeaways

• 😀 The abdomen is divided into four quadrants: Right Upper, Left Upper, Right Lower, and Left Lower, based on the umbilicus and midline.
• 😀 The abdomen can also be divided into nine regions, including hypochondrium, epigastrium, lumbar, iliac, and suprapubic (hypogastrium).
• 😀 Begin the physical examination with inspection to observe for abdominal distention, asymmetry, or abnormal movements during respiration.
• 😀 Auscultation is used to assess bowel sounds; normal sounds occur 6-12 times per minute, while deviations may indicate conditions like ileus or obstruction.
• 😀 Percussion of the abdomen is done to assess for abnormalities such as liver size, ascites, or masses, using the middle finger for tapping.
• 😀 Liver span is measured via percussion; normal range is 6-12 cm along the midclavicular line.
• 😀 Ascites detection involves percussion for shifting dullness, where the sound changes from tympany to dullness with fluid accumulation.
• 😀 During palpation, the abdomen is gently pressed to check for tenderness, masses, or enlarged organs like the liver, spleen, or kidneys.
• 😀 Liver enlargement can be checked by palpation during inspiration, feeling for any masses below the rib cage.
• 😀 Kidney enlargement is assessed using a bimanual technique, palpating the lower ribs and checking for any palpable masses or abnormal movement.
• 😀 Costovertebral angle (CVA) tenderness is checked by tapping the back at the rib-vertebra junction to detect kidney-related pain or discomfort.

Q & A

What are the four quadrants of the abdomen mentioned in the script?

The four quadrants of the abdomen are: Right Upper Quadrant, Left Upper Quadrant, Right Lower Quadrant, and Left Lower Quadrant. These are determined by drawing a horizontal line passing through the umbilicus and a vertical line in alignment with the midline of the sternum.

What is the alternative division of the abdomen into nine regions?

The abdomen can also be divided into nine regions. This is done by drawing horizontal lines just above the costal margin and just below the umbilicus, and vertical lines along the midclavicular lines. The nine regions are: Right Hypochondrium, Epigastrium, Left Hypochondrium, Right Lumbar, Umbilical, Left Lumbar, Right Iliac, Hypogastric, and Left Iliac.

What is the purpose of observing the movement of the abdominal wall during inspection?

The purpose is to assess the symmetry and any abnormalities in movement during respiration. Abnormalities, such as reduced movement in one part of the abdomen, may indicate issues like peritonitis.

What is the significance of auscultation during an abdominal examination?

Auscultation helps assess the frequency and quality of bowel sounds. Normal bowel sounds are between 6-12 per minute. Changes, such as reduced or increased sounds, can indicate conditions like ileus or gastrointestinal infections.

How is percussion performed in an abdominal examination?

Percussion is performed using the middle finger of the right hand to tap the middle finger of the left hand, placed on the abdominal wall. The technique helps assess the presence of gas, fluid, and organ enlargement, and is used to identify conditions like ascites.

What does the change in percussion sound from tympany to dullness indicate?

A change from tympany (a hollow sound) to dullness (a solid or fluid-filled sound) can indicate the presence of conditions like ascites, organ enlargement, or tumors.

How is the liver size assessed during palpation?

The liver is assessed by palpating the right costal margin while the patient inhales. The liver can be palpated if it is enlarged, and the exam helps identify any abnormalities in its size or texture.

What is the method for checking for splenomegaly (enlarged spleen)?

To check for splenomegaly, the examiner palpates along the left subcostal line and asks the patient to breathe in. The examiner feels for any mass or enlargement in the spleen. If a mass is felt, it may indicate splenomegaly.

What does a positive renal palpation indicate?

A positive renal palpation, where the kidney can be felt during a bimanual examination, may indicate renal enlargement, such as in cases of polycystic kidney disease or other renal pathologies.

What is the significance of the kidney percussion test?

The kidney percussion test involves tapping on the costovertebral angle (where the ribs meet the spine). If pain is elicited, it may indicate kidney infection or other renal problems such as nephritis or kidney stones.