‭NCM‬‭101‬‭:‬‭Lecture‬

‭ANATOMY‬‭OF‬‭THE‬‭ABDOMEN‬‭AND‬‭PELVIS‬
‭GASTROINTESTINAL‬‭SYSTEM‬
‭➢‬ ‭stomach‬
‭○‬ ‭is‬‭a‬‭reverse‬‭j‬‭pouch‬
‭○‬ ‭main‬‭function:‬‭store‬‭&‬‭breakdown‬‭food‬
‭○‬ ‭it‬‭contains‬‭a‬‭powerful‬‭substance‬‭that‬‭is‬‭use‬‭to‬‭breakdown‬‭a‬‭food‬
‭○‬ ‭cells‬
‭■‬ ‭parietal‬‭cells‬
‭●‬ ‭releases‬‭the‬‭HYDROCHLORIC‬‭ACID‬‭(gastric‬‭juice)‬
‭○‬ ‭extremely‬ ‭powerful‬ ‭that‬ ‭is‬ ‭used‬ ‭to‬ ‭chemically‬
‭breakdown‬‭the‬‭food‬
‭●‬ ‭1-3‬‭ph‬
‭■‬ ‭goblet‬‭cells‬
‭●‬ ‭releases‬‭PROTECTIVE‬‭MUCOSA‬
‭●‬ ‭It‬‭protects‬‭the‬‭stomach‬‭from‬‭small‬‭gastric‬‭acid‬
‭■‬ ‭mucosal‬‭cells‬
‭●‬ ‭extremely‬‭important‬ ‭because‬‭they‬‭are‬‭the‬‭once‬‭releases‬
‭INTRINSIC‬ ‭FACTORS‬ ‭—‬ ‭this‬ ‭is‬ ‭an‬ ‭enzyme‬ ‭used‬ ‭to‬
‭absorb‬‭a‬‭specific‬‭type‬‭of‬‭vitamin‬‭known‬‭as‬‭VITAMIN‬‭B12‬
‭○‬ ‭enzymes‬
‭■‬ ‭pepsin‬‭—‬‭are‬‭released‬‭by‬‭H‬‭cells‬
‭●‬ ‭It‬‭is‬‭an‬‭enzymes‬‭use‬‭to‬‭breakdown‬‭proteins‬
‭○‬ ‭regions‬
‭■‬ ‭cardiac‬‭region‬‭—‬‭it‬‭connects‬‭itself‬‭to‬‭the‬‭esophagus‬
‭●‬ ‭it‬ ‭contains‬ ‭a‬ ‭sphincter‬ ‭LOWER‬ ‭ESOPHAGUS‬
‭SPHINCTER‬
‭■‬ ‭fundus‬‭—‬‭head‬‭part‬‭of‬‭the‬‭stomach‬
‭■‬ ‭body‬
‭■‬ ‭antrum‬‭—‬‭common‬‭sight‬‭of‬‭GASTRIC‬‭ULCER‬
‭●‬ ‭this‬‭area‬‭is‬‭very‬‭thin‬‭at‬‭risk‬‭for‬‭erosion‬
‭■‬ ‭pylorus‬‭—-‬‭junction‬‭between‬‭the‬‭duodenum‬‭&‬‭stomach‬
‭●‬ ‭pyloric‬ ‭sphincter‬ ‭—‬ ‭act‬ ‭as‬ ‭a‬ ‭gate‬ ‭that‬ ‭prevents‬‭rapid‬
‭entry‬‭of‬‭food‬‭from‬‭stomach‬‭to‬‭the‬‭small‬‭intestine‬
‭➢‬ ‭small‬‭intestine‬
‭○‬ ‭duodenum‬
‭■‬ ‭length‬‭:‬‭1‬‭meter‬
‭■‬ ‭second‬‭site‬‭of‬‭protein‬‭breakdown‬
‭■‬ ‭AMPULLA‬ ‭OF‬ ‭VATER‬ ‭—‬ ‭this‬ ‭is‬ ‭a‬ ‭duct‬ ‭from‬ ‭pancreas‬ ‭that‬
‭extends‬ ‭to‬ ‭the‬ ‭common‬ ‭bile‬ ‭duct‬ ‭(‬ ‭CMD‬ ‭is‬ ‭connected‬ ‭to‬
‭gallbladder)‬
‭●‬ ‭exit‬‭mechanism‬
‭●‬ ‭exocrine‬‭glands‬
‭■‬ ‭site‬‭for‬‭PROTEIN‬‭AND‬‭FAT‬‭BREAKDOWN‬
‭○‬ ‭jejunum‬
‭■‬ ‭second‬‭layer‬‭of‬‭the‬‭small‬‭intestine‬
‭■‬ ‭much‬‭longer‬‭approximately‬‭2‬‭meters‬
‭■‬ ‭first‬‭site‬‭of‬‭nutrient‬‭absorption‬
‭■‬ ‭nutrients‬ ‭:‬ ‭protein‬ ‭(amino‬ ‭acids),‬ ‭fats‬ ‭(fatty‬ ‭acid)‬ ‭,‬
‭carbohydrates‬‭(glucose)‬
‭○‬ ‭ileum‬
‭■‬ ‭longest‬‭approximately‬‭7‬‭meters‬
‭■‬ ‭contains‬ ‭a‬ ‭fingerlike‬ ‭projections‬ ‭known‬ ‭to‬ ‭be‬ ‭INTESTINAL‬
‭VILLI‬‭—‬‭is‬‭responsible‬‭for‬‭nutrients‬‭absorption‬
‭■‬ ‭It‬‭contains‬‭a‬‭protective‬‭mechanism‬ ‭:‬
‭●‬ ‭PEYER'S‬‭PATCHES‬
‭○‬ ‭It‬ ‭contains‬ ‭macrophages‬ ‭—‬ ‭combats‬ ‭bacteria‬
‭that‬‭tries‬‭to‬‭invade‬‭the‬‭small‬‭intestine‬

‭38‬‭:‬‭EMA‬
 ‭NCM‬‭101‬‭:‬‭Lecture‬
‭➢‬ ‭large‬‭intestines‬
‭○‬ ‭parts‬
‭○‬ ‭cecum‬‭—‬‭is‬‭the‬‭first‬‭junction‬‭that‬‭connects‬‭the‬‭large‬‭intestine‬‭to‬
‭the‬‭small‬‭intestine‬
‭■‬ ‭It‬ ‭contains‬ ‭a‬ ‭certain‬ ‭type‬ ‭of‬ ‭valve‬ ‭known‬ ‭to‬ ‭be‬
‭ILEOCECAL‬ ‭VALVE‬ ‭–‬ ‭it‬ ‭protects‬ ‭the‬ ‭small‬ ‭intestine‬
‭from‬‭the‬‭microorganism‬‭from‬‭the‬‭large‬‭intestine‬
‭○‬ ‭appendix‬‭—‬‭worm‬‭like‬‭structure‬‭,‬
‭■‬ ‭In‬‭general‬‭it‬‭has‬‭no‬‭function‬
‭○‬ ‭ascending‬‭colon‬
‭○‬ ‭transverse‬‭colon‬
‭(junction‬‭between‬‭ascending‬‭&‬‭transverse‬ ‭colon:‬‭hepatic‬‭flexure)‬
‭‬ d
○ ‭ escending‬‭colon‬
‭○‬ ‭sigmoid‬‭colon‬
‭(junction‬‭descending‬‭&‬‭sigmoid‬‭colon‬‭:‬‭splenic‬‭flexure)‬
‭ ‬ ‭rectum‬
○
‭○‬ ‭functions‬
‭■‬ ‭water‬‭reabsorption‬
‭■‬ ‭electrolyte‬‭reabsorption‬
‭■‬ ‭acid‬‭base‬‭buffer‬‭—‬‭HCO3‬‭ions‬
‭■‬ ‭synthesis‬‭of‬‭vitamin‬‭K‬‭—‬‭colonic‬‭bacteria‬‭are‬‭responsible‬‭for‬‭the‬
‭production‬‭of‬‭the‬‭VK‬
‭●‬ ‭purpose‬‭of‬‭vitamin‬‭k‬
‭○‬ ‭responsible‬‭for‬‭clotting‬‭factors‬‭synthesis‬
‭■‬ ‭formation‬‭of‬‭feces‬
‭■‬ ‭stores‬‭feces‬‭until‬‭eliminated‬‭—‬‭rectum‬
➢
‭ ‬ ‭anus‬
‭○‬ ‭exit‬‭of‬‭feces‬
‭○‬ ‭contains‬‭2‬‭sphincter‬ ‭—‬‭innervated‬‭by‬‭CN‬‭V‬
‭■‬ ‭external‬
‭■‬ ‭Internal‬
‭➢‬ ‭spleen‬
‭○‬ ‭removing‬‭old‬‭RBC‬‭&‬‭platelets‬
‭○‬ ‭serve‬‭as‬‭graveyard‬‭for‬‭old‬‭RBC‬
‭○‬ ‭It‬‭also‬‭produces‬‭WBC‬‭and‬‭platelets‬
‭○‬ ‭location‬‭:‬‭left‬‭upper‬‭quadrant‬‭,‬‭between‬‭9-11th‬‭rub‬

‭BILIARY‬‭SYSTEM‬
‭●‬ ‭liver‬
‭○‬ m ‭ ain‬‭DETOXIFIER‬‭of‬‭the‬‭body‬
‭○‬ ‭responsible‬‭for‬‭the‬‭storage‬‭of‬‭FAT‬‭SOLUBLE‬‭VITAMINS‬‭(ADEK)‬
‭■‬ ‭A‬‭-‬‭retinol‬
‭■‬ ‭D‬‭-‬‭calciferol‬
‭■‬ ‭E-‬‭tocopherol‬
‭■‬ ‭K‬‭-‬‭ph‬
‭○‬ ‭produces‬‭BILE‬
‭○‬ ‭converts‬‭glucose‬‭to‬‭glycogen‬
‭○‬ ‭What‬‭process‬‭that‬‭transports‬‭glycogen‬‭to‬‭glucose?‬‭Glycogenolysis‬
‭○‬ ‭Producing‬‭glucose‬‭from‬‭non-carbohydrates‬‭sources?‬‭gluconeogenesis‬
‭○‬ ‭metabolizes‬‭carbohydrates,‬‭proteins‬‭,‬‭and‬‭fats‬
‭○‬ ‭excretes‬‭BILIRUBIN‬
‭○‬ ‭synthesis‬‭,‬‭stores‬‭and‬‭secretes‬‭cholesterol‬
‭○‬ ‭metabolizes‬‭proteins‬
‭○‬ ‭produces‬ ‭clotting‬‭factors‬
‭●‬ ‭pancreas‬
‭○‬ ‭serves‬‭as‬
‭■‬ ‭exocrine‬‭:‬‭digestion‬
‭●‬ ‭trypsin‬‭—‬ ‭protein‬
‭●‬ ‭lipase‬‭—‬‭fats‬

‭39‬‭:‬‭EMA‬
 ‭NCM‬‭101‬‭:‬‭Lecture‬
‭●‬ ‭amylase‬‭—‬‭carbohydrates‬
‭■‬ ‭endocrine‬
‭●‬ ‭insulin‬‭—‬‭glucose‬‭absorption‬‭in‬‭cells‬
‭●‬ ‭glucagon‬‭—‬‭emergency‬‭source‬‭of‬‭glucose‬
‭●‬ ‭somatostatine‬ ‭(growth‬ ‭hormone‬ ‭)‬ ‭—‬ ‭responsible‬ ‭for‬
‭tissue‬‭repairs‬
‭ ‬ ‭gallbladder‬
●
‭○‬ ‭STORES‬‭BILE‬

‭GENITOURINARY‬‭TRACT‬
‭●‬ ‭kidney‬
‭○‬ ‭posterior‬‭in‬‭the‬‭abdomen‬
‭○‬ ‭Right‬‭kidney‬‭is‬‭LOWER‬‭than‬‭the‬‭left‬‭kidney‬‭because‬‭of‬‭the‬‭liver‬
‭○‬ ‭It‬ ‭primary‬ ‭function‬ ‭is‬ ‭to‬ ‭FILTERS‬ ‭AND‬ ‭REMOVES‬‭WASTE‬‭PRODUCT‬
‭and‬‭also‬‭it‬‭produces‬‭the‬‭URINE‬‭in‬‭the‬‭body‬
‭○‬ ‭It‬‭also‬‭controls‬‭BP‬‭(release‬‭of‬‭renin)‬‭and‬‭management‬‭of‬ ‭RAAS‬
‭○‬ ‭maintains‬‭PROTEIN‬‭,‬‭FLUID‬‭,‬‭and‬‭ELECTROLYTES‬‭BALANCE‬
‭■‬ ‭because‬ ‭kidneys‬ ‭are‬ ‭responsible‬ ‭for‬ ‭reabsorption‬ ‭of‬ ‭protein‬ ‭,‬
‭fluid‬‭,‬‭and‬‭electrolytes‬‭balance‬
‭○‬ ‭nephrons‬‭of‬‭kidneys‬‭are‬‭composed‬‭of‬‭glomerulus‬‭—‬‭creates‬‭urine‬
‭○‬ ‭releases‬‭erythropoietin‬‭for‬‭RBC‬‭production‬
‭●‬ ‭ureters‬
‭○‬ ‭is‬‭a‬‭duct‬‭that‬‭connects‬‭the‬‭kidney‬‭to‬‭urinary‬‭bladder‬
‭●‬ ‭bladder‬
‭○‬ ‭stores‬‭urine‬‭until‬‭urination‬‭(urinary‬‭bladder)‬

‭REGIONS‬‭OF‬‭THE‬‭ABDOMEN‬
‭ .‬
1 r‭ ight‬‭hypochondria‬
‭2.‬ ‭epigastric‬
‭3.‬ ‭left‬‭hypochondria‬
‭4.‬ ‭right‬‭lumbar‬
‭5.‬ ‭umbilical‬
‭6.‬ ‭left‬‭lumber‬
‭7.‬ ‭right‬‭inguinal/iliac‬
‭8.‬ ‭hypogastric‬
‭9.‬ ‭left‬‭inguinal/iliac‬

‭QUADRANTS‬‭OF‬‭THE‬‭ABDOMEN‬

‭Right‬‭Upper‬‭Quadrant‬ ‭Left‬‭Upper‬‭Quadrant‬ ‭Right‬‭Lower‬ ‭Left‬‭Lower‬

‭Quadrant‬ ‭Quadrant‬

‭Liver‬ ‭Stomach‬ ‭Appendix‬ ‭Left‬‭ovary‬

‭ allbladder‬
G ‭Spleen‬ ‭Cecum‬ ‭ eft‬‭fallopian‬‭tube‬
L
‭Duodenum‬ ‭Pancreatic‬‭body‬‭tail‬ ‭Ascending‬‭colon‬ ‭Left‬‭spermatic‬‭cord‬
‭Ascending‬‭colon‬ ‭Left‬‭kidney‬ ‭right‬‭ovary‬ ‭Left‬‭ureter‬
‭Hepatic‬‭flexure‬ ‭Left‬‭adrenal‬‭glands‬ ‭Right‬‭fallopian‬‭tube‬ ‭Descending‬‭colon‬
‭Part‬‭of‬‭transverse‬‭colon‬ ‭Left‬‭ureter‬ ‭Right‬‭ureter‬ ‭Sigmoid‬‭colon‬
‭Pancreatic‬‭head‬ ‭Splenic‬‭flexure‬ ‭Right‬‭spermatic‬‭cord‬ ‭Aorta‬‭(portion)‬
‭Right‬‭kidney‬ ‭Portion‬‭of‬‭transverse‬‭colon‬ ‭Aorta‬‭(portion)‬ ‭Iliac‬‭artery‬
‭Right‬‭adrenal‬‭gland‬ ‭Descending‬‭colon‬ ‭Iliac‬‭artery‬
‭Right‬‭ureter‬ ‭Uterus‬‭(fundal)‬
‭Portion‬‭of‬‭aorta‬ ‭Aorta‬‭(portion)‬
‭Renal‬‭artery‬ ‭Renal‬‭artery‬

‭40‬‭:‬‭EMA‬
 ‭NCM‬‭101‬‭:‬‭Lecture‬

‭ASSESSMENT‬‭OF‬‭ABDOMEN‬‭AND‬‭PELVIS‬

‭Subjective‬‭Data‬
‭1.‬ ‭nutrition‬
‭○‬ ‭always‬‭ask‬‭for‬‭ALLERGIES‬
‭■‬ ‭related‬‭to‬
‭●‬ ‭food‬
‭●‬ ‭drugs‬
‭●‬ ‭objects‬
‭○‬ ‭BMI‬
‭■‬ ‭always‬‭ask‬‭for‬‭the‬‭height‬‭(meters)‬‭&‬‭weight‬‭(kilograms)‬
‭■‬ ‭how‬‭to‬‭compute:‬‭(w(kg)/h(m))2‬
‭■‬ ‭parameters‬‭in‬‭BMI‬‭assessment:‬
‭●‬ ‭normal‬ ‭—‬‭18.5‬‭-24.9‬
‭●‬ ‭Underweight‬‭—‬‭<18.5‬
‭●‬ ‭overweight‬ ‭—‬‭25-29.9‬
‭●‬ ‭obese‬ ‭—‬‭30‬‭and‬‭above‬
‭○‬ ‭hydration‬
‭■‬ ‭ask‬‭for‬‭the‬‭pts‬‭references‬‭regarding‬‭drink‬
‭■‬ ‭ask‬‭for‬‭water‬‭intake‬
‭■‬ ‭other‬‭fluid‬‭intake‬
‭■‬ ‭daily‬
‭2.‬ ‭symptoms‬‭related‬‭to‬‭GASTROINTESTINAL‬‭PROBLEMS‬
‭■‬ ‭nausea‬‭and‬‭vomiting‬
‭●‬ ‭Duration‬
‭●‬ ‭Frequency‬
‭●‬ ‭Amount‬
‭●‬ ‭consistency‬
‭■‬ ‭diarrhea‬
‭●‬ ‭duration‬
‭●‬ ‭frequency‬
‭●‬ ‭color‬
‭■‬ ‭constipation‬
‭●‬ ‭the‬‭difficulty‬‭in‬‭defecation‬
‭●‬ ‭duration‬‭(onset)‬
‭3.‬ ‭family‬‭history‬
‭●‬ ‭familial‬‭diseases‬
‭○‬ ‭inflammatory‬‭bowel‬‭disease‬
‭■‬ ‭crohn's‬‭disease‬
‭■‬ ‭ulcerative‬‭colitis‬
‭○‬ ‭colorectal‬‭cancer‬
‭○‬ ‭Irritable‬‭bowel‬‭syndrome‬‭(IBS)‬
‭4.‬ ‭personal‬‭history‬‭of‬‭GI‬‭problems‬
‭●‬ ‭GI‬‭infections‬
‭○‬ ‭ameniasis‬
‭○‬ ‭infectious‬‭diarrhea‬
‭●‬ ‭gallbladder‬‭disease‬
‭○‬ ‭cholecystitis‬
‭○‬ ‭cholelitiasis‬
‭●‬ ‭liver‬‭disease‬
‭○‬ ‭hepatitis‬
‭○‬ ‭liver‬‭cirrhosis‬
‭○‬ ‭liver‬‭masses‬
‭●‬ ‭denated‬‭laboratory‬‭test‬‭result‬
‭○‬ ‭cholesterol‬
‭○‬ ‭bilirubin‬
‭○‬ ‭liver‬‭enzymes‬
‭○‬ ‭glucose‬‭level‬

‭41‬‭:‬‭EMA‬
 ‭NCM‬‭101‬‭:‬‭Lecture‬
‭ ‬ ‭electrolyte‬‭level‬
○
‭○‬ ‭lipid‬‭levels‬
‭■‬ ‭triglycerides‬
‭■‬ ‭LDL‬
‭■‬ ‭VLDL‬

‭5.‬ ‭habits‬
‭●‬ a ‭ lcoholism‬‭—‬‭duration‬
‭●‬ ‭smoking‬
‭●‬ ‭diet‬
‭○‬ ‭preferences‬
‭○‬ ‭contents‬
‭○‬ ‭cooked‬‭or‬‭uncooked‬
‭●‬ ‭illicit‬‭drugs‬
‭○‬ ‭injectables‬

‭PHYSICAL‬‭EXAMINATION‬

‭Inspection‬
‭●‬ ‭the‬‭first‬‭thing‬‭you‬‭need‬‭to‬‭inspect‬‭is‬‭ABDOMINAL‬‭GIRTH‬
‭○‬ ‭this‬‭regards‬‭to‬‭abdominal‬‭circumference‬
‭○‬ ‭tool‬‭:‬‭tape‬‭measure‬
‭○‬ ‭when‬‭trying‬‭to‬‭assess‬‭abdominal‬‭girth‬‭you‬‭start‬‭at‬‭the‬‭level‬‭of‬‭umbilicus‬
‭○‬ ‭normal‬‭:‬
‭■‬ ‭men‬‭:‬‭75-90‬‭cm‬
‭■‬ ‭women:‬‭70-75‬‭cm‬
‭○‬ ‭abnormal‬
‭■‬ ‭abdominal‬‭enlargement‬
‭●‬ ‭usually‬ ‭cause‬ ‭by‬‭CONGESTION‬‭INSIDE‬‭THE‬‭PORTAL‬
‭FLOW‬ ‭OF‬ ‭THE‬ ‭PORTAL‬ ‭SYSTEM‬ ‭a‬ ‭condition‬ ‭known‬
‭ASCITES‬
‭●‬ ‭abdominal‬‭SKIN‬‭COLOR‬
‭○‬ ‭you‬‭need‬‭to‬‭observe‬‭skin‬‭of‬‭the‬‭abdomen‬
‭○‬ ‭take‬‭note‬‭for‬‭presences‬‭of‬‭SCARS‬‭and‬‭ABNORMAL‬‭MARKING‬
‭○‬ ‭normal:‬‭skin‬‭is‬‭LIGHTER‬‭than‬‭the‬‭exposed‬‭skin‬‭area‬
‭○‬ ‭abnormal‬
‭■‬ ‭(+)‬‭gray‬‭turner‬‭signs‬
‭●‬ ‭RETROPERITONEAL‬ ‭BLEEDING‬ ‭characterized‬ ‭by‬
‭bluish-black‬‭discoloration‬‭at‬‭the‬‭umbilical‬‭area‬‭spreading‬
‭to‬‭the‬‭flank‬‭area‬
‭●‬ ‭usually‬‭cause:‬
‭○‬ ‭ABDOMINAL‬‭AORTIC‬‭ANEURYSM‬‭(AOA)‬‭that‬
‭usually‬‭RAPTURE‬
‭○‬ ‭acute‬‭hemorrhagic‬‭pancreatitis‬‭(AHP)‬
‭■‬ ‭stria‬‭(stretch‬‭marks)‬
‭●‬ ‭usually‬‭cause:‬
‭○‬ ‭HYPERPIGMENTED‬ ‭OR‬ ‭HYPOPIGMENTED‬
‭areas‬ ‭of‬ ‭the‬ ‭abdomen‬ ‭due‬ ‭to‬ ‭CHRONIC‬
‭ENLARGEMENT‬
‭○‬ ‭may‬ ‭also‬ ‭be‬ ‭cause‬ ‭by‬ ‭HORMONAL‬
‭DISORDERS‬
‭○‬ ‭endocrine‬ ‭disorders‬ ‭,‬ ‭like‬ ‭for‬ ‭example‬
‭CUSHING'S‬‭DISEASE‬
‭■‬ ‭liver‬‭cirrhosis‬‭—‬‭signs‬‭is‬‭ASCITES‬

‭●‬ ‭abdominal‬‭CONTOUR‬‭AND‬‭SYMMETRY‬
‭○‬ ‭check‬ ‭for‬ ‭the‬ ‭abdominal‬ ‭size‬ ‭in‬ ‭relation‬ ‭to‬ ‭its‬ ‭area.‬‭note‬‭fo‬‭skin‬‭color‬‭,‬
‭pattern‬‭and‬‭if‬‭applicable‬‭hair‬‭distribution‬

‭42‬‭:‬‭EMA‬
 ‭NCM‬‭101‬‭:‬‭Lecture‬
‭○‬ ‭normal:‬
‭■‬ ‭abdomen‬‭is‬‭SYMMETRICAL‬‭;‬‭skin‬‭is‬‭PROPERLY‬‭PIGMENTED‬
‭and‬‭there‬‭is‬‭EQUAL‬‭HAIR‬‭DISTRIBUTION‬
‭○‬ ‭abnormal:‬
‭■‬ ‭umbilical‬‭protrusion‬
‭●‬ ‭this‬ ‭is‬ ‭due‬ ‭to‬ ‭umbilical‬ ‭hernia‬‭,‬ ‭there‬ ‭is‬ ‭abnormal‬
‭opening‬‭under‬‭the‬‭umbilicus‬
‭■‬ ‭abdominal‬‭alopecia‬
‭●‬ ‭due‬ ‭low‬ ‭hormonal‬ ‭level‬ ‭,‬ ‭especially‬ ‭in‬ ‭testosterone‬
‭(common‬‭in‬‭men)‬
‭■‬ ‭(+)‬‭cullen's‬‭sign‬
‭●‬ ‭discoloration‬‭of‬‭the‬‭umbilical‬‭are‬‭due‬‭to‬‭BLEEDING‬
‭●‬ ‭sacral‬‭assessment‬‭and‬‭perianal‬‭assessment‬
‭○‬ ‭check‬ ‭sacral‬ ‭area‬ ‭for‬ ‭skin‬ ‭color‬ ‭changes‬ ‭and‬ ‭presences‬ ‭of‬‭lesions‬‭or‬
‭dimpling‬‭of‬‭hair/abnormal‬‭hair‬‭growth‬
‭○‬ ‭take‬‭note‬‭of‬‭the‬‭sphincter‬‭tone‬‭of‬‭the‬‭pt‬
‭○‬ ‭normal‬
‭■‬ ‭no‬ ‭lesions‬ ‭are‬ ‭noted‬ ‭on‬ ‭the‬ ‭sacral‬ ‭and‬ ‭perianal‬ ‭area‬ ‭,‬ ‭no‬‭skin‬
‭breakdown‬‭is‬‭observed‬
‭■‬ ‭anal‬‭sphincter‬‭should‬‭be‬‭closed‬‭at‬‭all‬‭times‬
‭■‬ ‭no‬‭bleeding‬‭should‬‭be‬‭noted‬‭at‬‭the‬‭anal‬‭area‬
‭○‬ ‭abnormal‬
‭■‬ ‭anal‬‭warts‬
‭●‬ ‭lesions‬‭in‬‭the‬‭anal‬‭area‬‭due‬‭to‬ ‭Human‬‭papillomavirus‬
‭infection‬
‭●‬ ‭Quite‬‭contagious‬
‭●‬ ‭color‬‭ranges‬‭from‬‭pinkish‬‭to‬‭dark-brown‬‭in‬‭color‬
‭●‬ ‭spread‬‭through‬‭SEXUAL‬‭CONTACT‬
‭●‬ ‭hemorrhoids‬‭(almoranas)‬
‭○‬ ‭dilated‬‭anal‬‭vessels‬‭due‬‭to‬‭pressure‬‭change‬
‭○‬ ‭often‬‭caused‬‭by‬‭prolonged‬‭straining‬‭of‬‭the‬‭strol‬
‭■‬ ‭pressure‬‭ulcers‬‭(bedsores)‬
‭●‬ ‭due‬‭to‬‭prolonged‬‭immobility‬
‭●‬ ‭common‬‭areas‬‭of‬‭affectation‬‭is‬‭the‬‭SACRAL‬‭AREA‬
‭AUSCULTATION‬
‭●‬ ‭use‬‭the‬‭diaphragm‬‭of‬‭the‬‭stethoscope‬
‭●‬ ‭listen‬‭for‬‭1-5‬‭minutes‬‭for‬‭bowel‬‭sounds‬
‭●‬ ‭follow‬‭the‬‭anatomical‬‭tract‬
‭○‬ ‭RLQ‬‭—‬‭RUQ‬‭—‬‭LUQ‬‭—‬‭LLQ‬
‭○‬ ‭if‬ ‭pain‬ ‭is‬ ‭present:‬ ‭SKIP‬ ‭the‬ ‭painful‬ ‭area‬ ‭and‬ ‭proceed‬ ‭to‬ ‭the‬ ‭next‬
‭quadrant.‬
‭○‬ ‭auscultate‬‭the‬‭painful‬‭area‬‭,‬‭LAST‬
‭●‬ ‭take‬ ‭note‬ ‭of‬ ‭the‬ ‭sounds‬ ‭heard‬ ‭;‬ ‭including‬ ‭the‬ ‭quality‬‭bowel‬‭sounds‬‭and‬‭vessel‬
‭sound‬
‭●‬ ‭normal‬
‭○‬ ‭bowel‬‭sounds‬‭are‬‭heard‬‭at‬‭the‬‭rate‬‭of‬‭one‬‭sound‬‭every‬‭15-20‬‭seconds.‬
‭○‬ ‭sound‬‭is‬‭GURGLING‬‭in‬‭nature‬
‭○‬ ‭NO‬‭BRUITS‬ ‭should‬‭be‬‭heard‬

‭Abnormal‬
‭Abdominal‬‭bruit‬ t‭ urbulent‬ ‭blood‬ ‭flow‬ ‭in‬ ‭the‬
‭abdominal‬ ‭vessels‬ ‭and‬ ‭usually‬
‭caused‬‭by‬‭narrowing‬

‭Abdominal‬‭vessels‬ ‭ sually‬ ‭cause‬ ‭by‬‭AAA‬‭(abdominal‬

u
‭aortic‬‭aneurysm)‬

‭43‬‭:‬‭EMA‬
 ‭NCM‬‭101‬‭:‬‭Lecture‬

‭Hypoactive‬‭bowel‬‭sounds‬ ‭ owel‬ ‭sounds‬ ‭are‬ ‭present‬ ‭once‬

b
‭every‬‭5‬‭MINUTES‬

‭Hyperactive‬‭bowel‬‭sounds‬ ‭●‬ b ‭ owel‬ ‭sounds‬ ‭are‬ ‭heard‬

‭once‬‭every‬‭5‬‭SECONDS‬‭or‬
‭less‬
‭●‬ ‭loud‬ ‭gurgling‬ ‭sounds‬ ‭are‬
‭known‬‭as‬‭BORBORYGMI‬

‭Paralytic‬‭ileus‬ ‭ bsent‬ ‭bowel‬ ‭sounds‬ ‭due‬ ‭to‬

a
‭anesthesia‬ ‭effect‬ ‭but‬ ‭sometimes‬
‭this‬‭is‬‭NEUROGENIC‬‭in‬‭origin‬

‭PERCUSSION‬
‭●‬ ‭sequence‬‭is‬‭always‬‭ANATOMICAL‬‭TRACT‬
‭●‬ ‭percuss‬‭over‬‭the‬‭intestinal‬‭field‬‭(small‬‭intestine)‬‭from‬‭RLQ‬‭across‬‭the‬‭umbilicus‬
‭●‬ ‭gently‬‭tap,‬‭do‬‭not‬‭use‬‭fist‬
‭●‬ ‭by‬‭percussion‬‭approximately‬‭measure‬‭the‬‭size‬‭of‬‭organs‬
‭○‬ ‭there‬‭are‬‭only‬‭2‬‭organs‬‭that‬‭you‬‭need‬‭to‬‭measure‬
‭■‬ ‭liver‬ ‭in‬‭the‬‭RUQ‬
‭■‬ ‭spleen‬‭in‬‭the‬‭LUQ‬
‭●‬ ‭percuss‬‭the‬‭kidneys‬‭at‬‭the‬‭costovertebral‬‭angle‬‭at‬‭the‬‭12th‬‭rib‬‭area‬
‭●‬ ‭normal‬
‭○‬ ‭men:‬‭liver‬‭had‬‭a‬‭size‬‭of‬‭8-11‬‭cm‬
‭○‬ ‭women‬‭:‬‭6-9‬‭cm‬
‭○‬ ‭DULL‬‭SOUND‬‭is‬‭expected‬‭over‬‭the‬‭liver‬‭area‬‭and‬‭spleen‬
‭○‬ ‭TYMPANY‬ ‭(low‬ ‭drum‬ ‭like‬ ‭sounds)‬‭is‬‭expected‬‭along‬‭the‬‭colonic‬‭tract‬
‭and‬‭intestinal‬‭fields‬
‭○‬ ‭TYMPANY‬ ‭is‬ ‭prominent‬ ‭over‬ ‭the‬ ‭epigastric‬ ‭area‬ ‭where‬ ‭stomach‬ ‭is‬
‭located‬ ‭(except‬‭in‬‭the‬‭liver‬‭area‬‭and‬‭spleen)‬
‭○‬ ‭kidney‬‭percussion‬‭should‬‭be‬‭PAIN‬‭FREE‬
‭○‬ ‭spleen‬‭normal‬‭size‬‭is‬‭APPROXIMATELY‬‭7‬‭CM‬
‭●‬ ‭abnormal‬
‭○‬ ‭DULL‬ ‭SOUND‬ ‭over‬ ‭area‬ ‭the‬ ‭tympany‬ ‭indicates‬ ‭PRESENCE‬ ‭OF‬
‭MASSES‬
‭○‬ ‭if‬ ‭liver‬ ‭is‬ ‭greater‬ ‭than‬ ‭normal‬ ‭size‬ ‭(8-11‬ ‭or‬ ‭6-9‬ ‭cm)‬ ‭,‬ ‭it‬ ‭indicated‬
‭HEPATOMEGALY‬
‭○‬ ‭if‬‭spleen‬‭is‬‭greater‬‭than‬‭7‬‭cm‬‭,‬‭it‬‭indicated‬‭SPLENOMEGALY‬
‭○‬ ‭if‬‭(+)‬‭pain‬‭in‬‭costovertebral‬‭angle‬ ‭,‬‭possible‬‭;‬
‭■‬ ‭NEPHRITIS‬‭(kidney‬‭inflammation)‬
‭■‬ ‭NEPHROLITHIASIS‬‭(kidney‬‭stones‬‭)‬‭is‬‭present‬
‭■‬ ‭the‬‭pain‬‭is‬‭severe‬‭pain‬‭and‬‭stabbing‬‭colicky‬ ‭pain‬
‭○‬ ‭RESONANCE‬ ‭SOUND‬ ‭in‬ ‭the‬ ‭abdomen‬ ‭indicated‬ ‭air‬ ‭trapping‬ ‭in‬ ‭the‬
‭abdomen‬‭either‬‭this‬‭will‬‭be‬‭caused‬‭by;‬
‭■‬ ‭gas‬‭distribution‬‭(panuhot)‬
‭■‬ ‭peritoneal‬ ‭area‬ ‭–‬ ‭large‬‭amount‬‭of‬‭air‬‭that‬‭is‬‭present‬‭peritoneal‬
‭cavity‬ ‭,‬ ‭a‬ ‭condition‬ ‭known‬‭PNEUMOPERITONEUM‬‭(‬‭shifting‬‭of‬
‭all‬‭the‬‭abdomen‬‭organs)‬
‭●‬ ‭It‬‭you‬‭will‬‭perform‬‭x-ray‬‭there‬‭will‬‭be‬‭a‬‭(+)‬‭football‬‭sign‬

‭PALPATION‬
‭●‬ ‭still‬‭anatomical‬‭tract‬

‭44‬‭:‬‭EMA‬
 ‭NCM‬‭101‬‭:‬‭Lecture‬
‭●‬ T ‭ he‬‭liver‬‭is‬‭usually‬‭palpated‬‭in‬‭the‬‭RIGHT‬‭UPPER‬‭QUADRANT‬‭and‬‭can‬‭only‬‭be‬
‭palpated‬‭using‬‭the‬‭DEEP‬‭PALPATION‬
‭●‬ ‭The‬ ‭spleen‬ ‭is‬ ‭usually‬ ‭palpated‬ ‭in‬ ‭the‬‭LEFT‬‭UPPER‬‭QUADRANT‬‭and‬‭can‬‭only‬
‭be‬‭palpated‬‭using‬‭the‬‭DEEP‬‭PALPATION‬
‭●‬ ‭first‬‭perform‬‭LIGHT‬‭PALPATION‬
‭○‬ ‭1cm‬‭depression‬
‭●‬ ‭followed‬‭by‬‭DEEP‬‭PALPATION‬
‭○‬ ‭5-8‬‭cm‬‭depression‬
‭○‬ ‭take‬‭not‬‭of‬‭RIDGES‬
‭●‬ ‭spleen‬‭—‬‭lower‬‭upper‬‭quadrant‬ ‭—‬‭deep‬‭palpation‬
‭●‬ ‭kidneys‬‭—‬‭at‬‭the‬‭flank‬‭area‬‭(CVA)‬‭—‬‭deep‬‭palpation‬
‭●‬ ‭aorta:‬‭moderate‬‭palpation‬‭in‬‭MID-UMBILICAL‬‭AREA‬‭and‬‭using‬‭the‬‭2‬‭fingertips‬
‭●‬ ‭urinary‬‭bladder:‬‭deep‬‭palpation‬‭at‬‭the‬‭SUPRAPUBIC‬‭AREA‬‭(hypogastric‬‭region)‬
‭●‬ ‭normal‬
‭○‬ ‭liver‬‭and‬‭spleen‬‭is‬‭usually‬‭NON-PALPABLE‬‭so‬‭is‬‭the‬‭kidneys‬
‭○‬ ‭liver‬‭borders‬‭should‬‭be‬‭SMOOTH‬
‭○‬ ‭aorta‬‭should‬‭be‬‭normally‬‭without‬‭thrills‬‭and‬‭is‬‭only‬‭2-3‬‭cm‬‭in‬‭width‬
‭●‬ ‭abnormal‬
‭○‬ ‭abdominal‬‭rigidity‬
‭■‬ ‭abdomen‬‭is‬‭hard‬‭and‬‭cannot‬‭be‬‭palpated‬ ‭due‬‭to‬‭inflammation‬
‭of‬‭peritoneum‬‭a‬‭condition‬‭known‬‭as‬‭PERITONITIS‬
‭■‬ ‭painful‬
‭○‬ ‭aortic‬‭thrills‬
‭■‬ ‭vibrating‬‭sensation‬‭upon‬‭palpation‬‭of‬‭the‬‭aorta‬‭due‬‭to‬‭abdominal‬
‭aortic‬‭aneurysm‬
‭○‬ ‭bladder‬‭distention‬
‭■‬ ‭urinary‬ ‭bladder‬ ‭is‬ ‭palpated‬ ‭at‬ ‭the‬ ‭umbilical‬ ‭area‬ ‭instead‬ ‭of‬ ‭the‬
‭hypogastric‬‭region‬‭caused‬‭by‬‭distended‬‭(unreleased‬‭urine)‬

‭SPECIAL‬‭TEST‬
‭1.‬ ‭fluid‬‭wave‬‭test‬
‭○‬ ‭test‬‭for‬‭ascites‬
‭○‬ ‭while‬‭supine‬‭.‬‭place‬‭one‬‭hand‬‭at‬‭the‬‭umbilical‬‭region‬‭then‬‭tap‬‭on‬‭the‬
‭opposite‬‭side‬‭(either‬‭at‬‭the‬‭left‬‭lumbar‬‭or‬‭right‬‭lumbar‬‭region‬‭)‬
‭○‬ ‭(+)‬‭fluid‬‭wave‬‭is‬‭felt‬‭on‬‭the‬‭umbilical‬‭area‬‭if‬‭pt‬‭has‬‭ascites‬
‭2.‬ ‭shifting‬‭dullness‬‭test‬
‭○‬ ‭test‬‭for‬‭ascites‬
‭○‬ ‭position‬‭is‬‭supine‬‭tap‬‭at‬‭umbilical‬‭region;‬‭a‬‭dull‬‭sound‬‭is‬‭expected‬‭to‬‭pt‬
‭with‬‭ascites‬
‭○‬ ‭position‬‭the‬‭pt‬‭side‬‭lying‬‭with‬‭dull‬‭sound‬‭shifts‬‭over‬‭the‬‭area‬‭where‬‭fluid‬
‭is‬‭moved‬‭,‬‭usually‬‭on‬‭one-side‬‭on‬‭the‬‭side-lying‬‭area‬
‭○‬ ‭only‬‭possible‬‭if‬‭the‬‭fluid‬‭is‬‭>‬‭500‬
‭3.‬ ‭blumberg‬‭sign‬
‭○‬ ‭test‬‭for‬‭appendicitis‬
‭○‬ ‭rebound‬‭tenderness‬
‭○‬ ‭palpate‬‭the‬‭right‬‭lower‬‭quadrant‬‭(‬‭McBurney's‬‭area),‬‭then‬‭release‬
‭○‬ ‭(+)‬ ‭pain‬ ‭is‬ ‭absent‬ ‭upon‬ ‭palpation‬ ‭and‬ ‭then‬ ‭pain‬ ‭is‬ ‭present‬ ‭after‬
‭releasing‬‭the‬‭palpation‬
‭4.‬ ‭rovsing‬‭sign‬
‭○‬ ‭palpate‬‭the‬‭left‬‭lower‬‭quadrant‬
‭○‬ ‭(+)‬‭after‬‭palpating‬‭the‬‭LLQ‬‭pain‬‭is‬‭felt‬‭on‬‭the‬‭right‬‭lower‬‭quadrant‬‭,‬‭this‬
‭is‬‭a‬‭sign‬‭REFERRED‬‭PAIN‬
‭5.‬ ‭sitkovsky‬‭sign‬‭(rosenstein’s‬‭sign)‬
‭○‬ ‭ask‬‭pt‬‭to‬‭position‬‭from‬‭supine‬‭then‬‭to‬‭left‬‭recumbent‬‭position‬
‭○‬ ‭(+)‬‭pain‬‭is‬‭present‬‭at‬‭the‬‭right‬‭lower‬‭quadrant‬
‭6.‬ ‭obturator‬‭sign‬
‭○‬ ‭raise‬‭pt‬‭legs‬‭towards‬‭the‬‭abdominal‬‭area‬
‭○‬ ‭(+)‬‭pain‬‭is‬‭present‬‭at‬‭the‬‭right‬‭lower‬‭quadrant‬

‭45‬‭:‬‭EMA‬
 ‭NCM‬‭101‬‭:‬‭Lecture‬
‭7.‬ ‭psoas‬‭sign‬
‭○‬ ‭palpate‬‭the‬‭tight‬‭right‬‭while‬‭raising‬‭leg‬‭up‬
‭○‬ ‭(+)‬‭pain‬‭is‬‭present‬‭at‬‭the‬‭right‬‭lower‬‭quadrant‬
‭8.‬ ‭dunphy‬‭sign‬
‭○‬ ‭ask‬‭the‬‭pt‬‭to‬‭cough‬‭while‬‭placing‬‭hands‬‭at‬‭the‬‭umbilical‬‭area‬
‭○‬ ‭(+)‬‭pain‬‭at‬‭the‬‭right‬‭lower‬‭quadrant‬‭is‬‭present‬
‭9.‬ ‭permans‬‭sign‬
‭○‬ ‭palpate‬‭at‬‭the‬‭left‬‭iliac‬‭crest‬‭or‬‭fossa‬
‭○‬ ‭(+)‬‭pain‬‭present‬‭at‬‭the‬‭right‬‭lower‬‭quadrant‬
‭10.‬ ‭murphy's‬‭sign‬
‭○‬ ‭ask‬‭the‬‭pt‬‭to‬‭deep‬‭breath‬‭whole‬‭palpating‬‭at‬‭the‬‭RQL‬
‭○‬ ‭(+)‬‭pain‬‭during‬‭inspiration‬‭and‬‭pt‬‭stops‬‭breathing‬
‭○‬ ‭(+)‬‭cholecystitis‬

‭46‬‭:‬‭EMA‬