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PEMERIKSAAN ABDOMEN

General Considerations
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The patient should have an empty bladder.


The patient should be lying supine on the exam table and
appropriately draped.
The examination room must be quiet to perform adequate
auscultation and percussion.
Watch the patient's face for signs of discomfort during the
examination.
Use the appropriate terminology to locate your findings
Disorders in the chest will often manifest with abdominal symptoms.
It is always wise to examine the chest when evaluating an abdominal
complaint.
Consider the inguinal/rectal examination in males. Consider the
pelvic/rectal examination in females.

EXAM SECTIONS
1. Inspection
2. Auscultation
3. Percussion
4. Palpation

1. INSPECTION
Physicians locate findings in the abdomen in one of
four quadrants or one of nine regions.
The four quadrants are:
right upper (RUQ),
right lower (RLQ),
left upper (LUQ) and
left lower (LLQ).
THE NINE REGIONS
epigastric,
umbilical,
hypogastric/suprapubic,
right hypochondriac,
left hypochondriac,
right lumbar,
left lumbar,
right inguinal and
left inguinal.

LOCATIONS of ABDOMINAL ORGANS


The schematic below is a reminder of what
organs are likely to produce findings in each
region.
For example:
Right hypochondriac (RUQ) : liver and gall
bladder
left hypochondriac (LUQ) : the spleen and
stomach
epigastric : the pancreas, stomach and
common bile duct
umbilical : the small intestine
lumbar : the kidneys
iliac regions : the ovaries
left iliac/LLQ : the sigmoid colon
right iliac or lumbar (RLQ): the cecum and
appendix
suprapubic : the bladder and uterus

SOME COMMON FINDINGS on ABDOMINAL


INSPECTION
Scars : Jaringan parut
Striae (stretch marks) : tanda peregangan ibu hamil
Colors : - Bluish color at the umbilicus is Cullen's sign a sign

of bleeding in the peritoneum.


- Bruises on the flanks are Grey Turner's sign
(retroperitoneal bleeding - e.g. from inflamed pancreas)

Jaundice : warna kuning pada kulit


Prominent veins : may be due to portal vein
obstruction or inferior vena cava obstruction

ABDOMINAL DISTENSION
Distension of the lower abdomen only can be
caused by pregnancy, full bladder, ovarian tumor,
or uterine fibroids (common benign growths)
Diffuse abdominal distension can be caused by any
of the 6 Fs:
Fat (obesity)
Fluid (ascites - peritoneal fluid - or obstructed viscera
filled with fluid)
Flatus (air) - e.g. from air swallowing or intestinal
obstruction
Feces (constipation
Fetus (pregnancy)
Fatal cancer.

2. AUSCULTATION
GUT SOUNDS

Use the diaphragm of your stethoscope to listen to gut sounds


Normal gut sounds are gurgling, 5 to 35 per minute
Borborygmi are loud, easily audible sounds. They are normal, too.
High pitched , tinkling (raindrops in a barrel) sounds are a sign of
early intestinal obstruction
Decreased sounds: (none for a minute) are a sign of decreased
gut activity. Gut sounds may be markedly decreased after
abdominal surgery; abdominal infection (peritonitis) or injury.
Absent Sounds : (no sounds for 5 minutes) are a bad sign. They
can be caused by longer-lasting intestinal obstruction, intestinal
perforation or intestinal (mesenteric) ischemia or infarction

3. PERCUSSION
What it finds: liver size (kind of), spleen, fluid.
Percussing the body gives one of three notes:
Tympany is found in most of the abdomen,
caused by air in the gut. It has a higher pitch
than the lung.
Resonance is found in normal lung. It is lower
pitched and hollow.
Dullness is a flat sound, without echoes. The
liver and spleen, and fluid in the peritoneum
(ascites: ah-SY-teez), give a dull note.

A. Liver Span
Percuss downward from the chest in the right midclavicular line
until you detect the top edge of liver dullness.
Percuss upward from the abdomen in the same line until you detect
the bottom edge of liver dullness.
Measure the liver span between these two points. This
measurement should be 6-12 cm in a normal adult.
B. Splenic Dullness
Percuss the lowest costal interspace in the left anterior axillary
line. This area is normally tympanitic.
Ask the patient to take a deep breath and percuss this area again.
Dullness in this area is a sign of splenic enlargement.

Shifting Dullness
This is a test for peritoneal fluid (ascites). ++
Percuss the patient's abdomen to outline areas of dullness and tympany.
Have the patient roll away from you.
Percuss and again outline areas of dullness and tympany. If the dullness has
shifted to areas of prior tympany, the patient may have excess peritoneal
fluid.
Psoas Sign
This is a test for appendicitis. ++
Place your hand above the patient's right knee.
Ask the patient to flex the right hip against resistance.
Increased abdominal pain indicates a positive psoas sign.
Obturator Sign
This is a test for appendicitis. ++
Raise the patient's right leg with the knee flexed.
Rotate the leg internally at the hip.
Increased abdominal pain indicates a positive obturator sign.

4. PALPATION
General Palpation
1. Begin with light palpation.
At this point you are mostly
looking for areas of
tenderness. The most
sensitive indicator of
tenderness is the patient's
facial expression (so watch
the patient's face, not your
hands). Voluntary or
involuntary guarding may
also be present.
2. Proceed to deep palpation
after surveying the abdomen
lightly. Try to identify
abdominal masses or areas
of deep tenderness

Palpation of the Liver


Standard Method
Place your fingers just below the right costal
margin and press firmly.
Ask the patient to take a deep breath.
You may feel the edge of the liver press
against your fingers. Or it may slide under
your hand as the patient exhales. A normal
liver is not tender.
Alternate Method
This method is useful when the patient is
obese or when the examiner is small
compared to the patient.
Stand by the patient's chest.
"Hook" your fingers just below the costal
margin and press firmly.
Ask the patient to take a deep breath.
You may feel the edge of the liver press
against your fingers.