ABDOMEN BASICS

Department of General Surgery!

cmchrc
 Basic concepts

• Quadrants of abdomen.

• Embryonal division.

• Non surgical causes of

abdominal pain.

• Acute symptoms.

• Chronic symptoms.
 History
Pain!

• Duration

• site

• Radiation/Referred

• food relation

• character - continuous / Periodicity

• Aggravating/ Relieving Factors

• Dyspepsia

• Vomiting - Character & amount, Relation with food

& Relief of pain

• Haematemesis

• malena

• Jaundice!

• constipation / diarrhoea / Altered bowel habits

• loss of weight

• loss of appetite

• fever
Examination of Abdomen
Inspection!

• contour of abdomen

• skin over the abdomen

• Umblicus

• Movements

• Hernial orifices, External Genitalia

• left supraclavicular fossa.

visible swelling: !

• Position & extent

• size,shape

• Movement with respiration

• carnett’s test
 Palpation
Warmth & Tenderness!

Swelling!

• position

• size,shape,surface

• margins,consistency

• mobility(Intrinsic Mobility)

• Pulsatile or not

• Plane of the swelling.

Specific organ: !

• Liver

• Gall Bladder

• spleen

• Kidney
• Hernial orifices and External genitalia

• Virchow’s node / Troisier’s sign - left supra

clavicular node (inbetween two heads of
sternocleidomastoid muscle).
 Percussion

• Liver span!

• shifting dullness
 Auscultation

• Bowel sounds
• Rectal examination

• Vaginal examination
Glimpse……
Movement with respiration
• All intra peritoneal organs having direct / indirect
communication with the diaphragm will move with
respiration.

• Intra peritoneal organs like uterus,ovary / RIF mass

which have no contact with diaphragm will not move

• All retroperitoneal organ & swelling - will not

move with respiration. Exception: kidney will have
minimal movement with respiration since it is
having contact with liver & spleen
Assessing Extent in abdominal lump!

Upper abdominal lump:!

• Sub costal margin

• Anterior axillary line

• Mid clavicular line

• Midline

Lower abdominal lump:!

• iliac crest

• Pubic Symphysis
 Renal angle

• Angle between 12th rib & erector spine muscle

• normally occupied by right & left colon on both

sides

• when kidney enlarges it will occupy the renal angle

 succussion splash

• Gurgling sound heard in the epigastrium by

shaking the patient.

• Due to stasis of fluid within the stomach in GOO

Comparison of liver & gastric mass

Similarities!

• Both occupy right hypochondrium & epigastric

region

• Both move well with respiration

• Both may have nodular surface

Comparison of liver & gastric mass
Differences
Liver! Stomach

Upper border not

Usually palpable
palpable

Band of resonance exist

Dullness continuous with
between mass & Liver
liver dullness
dullness
Not able to insunuate
finger between mass & Able to Insunuate finger
subcostal margin