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PEMERIKSAAN ABDOMEN

YAN
SETIAWAN

General
Considerations
The patient should have an empty bladder.

1.
2. The patient should be lying supine on the exam table and
appropriately draped.
3. The examination room must be quiet to perform adequate
auscultation and percussion.
4. Watch the patient's face for signs of discomfort during the
examination.
5. Use the appropriate terminology to locate your findings
6. Disorders in the chest will often manifest with abdominal
symptoms. It is always wise to examine the chest when
evaluating an abdominal complaint.
7. Consider the inguinal/rectal examination in males.
Consider the pelvic/rectal examination in females.
EXAM SECTIONS
1. Inspection
2. Auscultation
3. Percussion
4. Palpation

KONSEP DASAR PEMERIKSAAN


Prinsip
Dasar
FISIK
Data Subjektif (Allo/Auto anamnesa)
Data Objektif

Teknik

Inspeksi (periksa pandang/observasi)


Auskultasi (periksa dengar)
Perkusi (periksa ketuk)
Palpasi (periksa raba)

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
1. Dengarkan peristaltik usus dengan menggunakan bagian
diafragma stetoskop yang sebelumnya telah di hangatkan
dengan menggosok ditelapak tangan
2. Perhatikan karakter & frekuensi peristaltik usus di tiap
kuadran
3. Frekuensi peristaltik normal 5 - 35x/mnt atau tiap 5-15
detik sekali
4. Penurunan frekuensi peristaltik usus : post operasi
abdomen, peritonitis, trauma abdomen,ileus paralitik
5. Peristaltik usus negatif (tidak ada bunyi peristaltik usus
dalam 5 menit ): akibat obstruksi intestinal, perforasi usus,
infark/iskemik intestinal

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.

Perkusi Hepar :
o Garis midklavikula kanan mulai dari bawah umbilikus
keatas, sampai terdengar suara redup(dullness) yang
merupakan batas bawah hepar
o Lakukan perkusi dari daerah paru ke bawah untuk
menetukan batas atas hepar, ukurlah berapa sentimeter
tinggi daerah redup hepar tersebut
o Normal batas atas sampai bawah 6 - 12 cm di
midclavicular
Perkusi Lien :
o Perkusi daerah intercosta terbawah di garis axilaris
anterior kiri, kemudian minta pasien untuk inspirasi panjang
& lakukan perkusi lagi, jika klien tidak membesar suara
perkusi tetap timpani, apabila suara menjadi redup saat
inspirasi berarti ada pembesaran lien

4. PALPATION
Hepar :
Letakkan tangan kiri di
belakang pinggang
menyangga kosta ke 11 &
12 dengan posisi sejajar
dengan kosta, ajurkan
pasien untuk rileks, tangan
kanan mendorong hepar ke
atas dan kedalam dengan
lembut
Anjurkan pasien inspirasi
dalam & rasakan sentuhan
hepar saat inspirasi, jika
teraba sedikit kendorkan jari
& raba permukaan anterior
hepar

Lien :
Letakkan tangan kiri menyangga & mengangkat
kosta bagian bawah sebelah kiri pasien
Anjurkan pasien untuk inspirasi dalam & rasakan
sentuhan lien pada ujung jari, perhatikan apakah
ada nyeri tekan, bagaimana permukaannya,
perkirakan jarak antara lien dengan batas terendah
dari kosta kiri terbawah.

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.

QUESTIONS?