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  • Abdomen and Heart

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    selflessdoctor
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    The document describes examination findings of the heart and abdomen. On examination of the heart, the precordium was not bulging or depressed, neck veins were not distended, JVP was normal, PMI was at the 5th ICS LMCL, no lifts, thrills or murmurs were auscultated. Heart sounds S1 and S2 were normal with physiological splitting of S2. Peripheral pulses were normal. On abdominal exam, the abdomen was symmetrical with normal bowel sounds and no masses or tenderness on palpation. The liver and spleen were not palpable. Percussion found general tympanism and normal liver span.

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    The document describes examination findings of the heart and abdomen. On examination of the heart, the precordium was not bulging or depressed, neck veins were not distended, JVP was normal, PMI was at the 5th ICS LMCL, no lifts, thrills or murmurs were auscultated. Heart sounds S1 and S2 were normal with physiological splitting of S2. Peripheral pulses were normal. On abdominal exam, the abdomen was symmetrical with normal bowel sounds and no masses or tenderness on palpation. The liver and spleen were not palpable. Percussion found general tympanism and normal liver span.

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    6 views1 page

    Abdomen and Heart

    Uploaded by

    selflessdoctor
    The document describes examination findings of the heart and abdomen. On examination of the heart, the precordium was not bulging or depressed, neck veins were not distended, JVP was normal, PMI was at the 5th ICS LMCL, no lifts, thrills or murmurs were auscultated. Heart sounds S1 and S2 were normal with physiological splitting of S2. Peripheral pulses were normal. On abdominal exam, the abdomen was symmetrical with normal bowel sounds and no masses or tenderness on palpation. The liver and spleen were not palpable. Percussion found general tympanism and normal liver span.

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    of 1

    Heart: Abdomen:

    (Right side)
    (Tangential light at the apex) Drape pt, Right side, IAPP
    No bulging, no depression, adynamic precordium.
    (Turn head) No neck vein distention. Inspection
    (Measure JVP using 2 Ruler, Supine position 300) JVP is ___ cm H20. (Measure) Abdominal circumference is __ cm at the level of umbilicus.
    Abdomen is symmetrically (flat, round, distended, scaphoid or globular)
    (Palpation) No skin lesions, no superficial veins, no scars, and striae
    (Do inching, locate PMI then palpate for apical impulse with one finger) No hyperpigmentation/hypopigmentation (area_____, ____cm)
    PMI is at 5th ICS LMCL. Umbilicus is (inverted, flat, reverted)
    (Using finger pads and base of palms, palpate M-T-E-P-A) No visible peristalsis, no visible pulsation (abdominal aorta) above the
    No heaves, lifts and thrills. umbilicus

    Auscultation
    (Heart rate at the apex) Auscultate
    Heart rate is ____ bpm, normal rate, regular rhythm. Bowel sound is __ cycles/min.
    Normoactive/Hypoactive/Hyperactive bowel sound. (5-34/min)
    Supine position No bruit noted upon auscultation. (Abdominal aorta – diaphragm, renal
    (2nd Left ICS, 3rd ICS., 4th ICS, 5th ICS, then apex /APTM. Ask to breath. aortic bruit diaphragm and bell) (epigastric, RUQ, LUQ)
    Use diaphragm and bell)
    S1 is best heard at the apex. Palpate (ask the patient to relax or flex the knee, ask the painful area first)
    S2 is best heard at the base. Light Palpation
    Presence of physiological splitting of S2 On light palpation, abdomen is soft, no palpable mass, no tenderness.
    Left Lateral Decubitus – Bell at apex Deep Palpation (double handed)
    No S3, No S4 heart sound. No extra heart sounds On deep palpation, no palpable mass.
    Sit and Lean forward – Exhale and hold his breath – place diaphragm on Liver is not palpable, spleen is not palpable, both kidneys are not palpable.
    left sternal and apex.
    No murmurs.
    Percussion
    Supine, then turn head Abdomen exhibits generally tympanism.
    Carotid pulse is palpable, strong and bounding. Liver span is within normal limit.
    (Turn head, use Bell) No carotid bruit. Traube’s space (left 6th rib, left MAL , left subcostal area) is
    tympanitic/hyperresonant/dull.
    Peripheral pulses such as carotid, brachial, radial femoral, popliteal,
    posterior tibialis and dorsalis pedis are equally palpable, strong and
    bounding. Special Exam
    Acute Cholecystitis – +/- Murphy’s sign (Hingang malalim then press)
    Some expected outcomes: Acute AP – +/- Direct and rebound tenderness, +/- Psoas sign,
    Diaphragm – S1 and S2, the murmurs of aortic and mitral, regurgitation, +/- Obturator, +/- Markel’s sign, +/- Rovsing’s sign
    and pericardial friction rubs, physiological splitting of S2 Ascites – +/- Fluid wave, +/- shifting dullness, +/- Puddle sign
    Bell - S3 and S4 and the murmur of mitral stenosis.) Acute Pyelonephritis – +/- Costovertebral angle tenderness
    S1 is best heard at the apex.
    S2 is best heard at the base.
    Mitral stenosis - LLD
    Aortic regurgitation - lean forward

    Heart:

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