Abdominal examination Inspection Auscultation Palpation and Percussion

Hello everyone, I'm Dr. Nadim and I'm going to demonstrate very important medical examination today and that is abdominal examination. So what is the need of physical examination of abdomen? See actually before going for further examination of labs and radiological investigations good doctor does very good physical examination. After doing good physical examination you can have so many ideas about the pathologies which are residing in the body of patient. And for that have volunteer and she is Miss Hassni. Hello Miss Hassn. Hello doctor. I'm Dr. Nadim and want to look for some pathologies in your abdomen and for that I'm going to do physical examination on your abdomen. Are you comfortable? Yeah doctor I'm comfortable. And do you have any question? No question. Okay. need your cooperation. Yeah sure. Thank you so much. So ideal method of doing general physical examination first of all if male doctor is there and patient is female. So the most important thing is that there should be female attendant and with my patient she is having her mom here. Ideally we should have hospital staff and if there is unavailability of hospital staff then you can keep anyone as female attendant and light should be appropriate. I'm going to demonstrate all physical examination which are being done over abdomen. So what are the general examinations? First of all we have to do inspection visual inspection. After that we have to go for palpation and then percussion and then oscultation. There is sequence. See before inspection we cannot go for percussion or palpation because inspection is very very important without going to touch the patient. am not going to touch the patient. Now I'm just going to inspect and why this is so much important because when see my patient breathing and after that will check all the movements over abdomen and if there is any abnormality in the movement of abdomen I'm going to watch that. So inspection is very very important. I'm going to show you here. So what is the need of inspection of this abdomen now and what actually want to see here? want to look for any stri any hematoma or engorged veins over the abdomen. also want to see scar. Every scar has story behind it. So it's worth asking it. It could be possible that my patient had undergone some surgeries before that and because of that old surgery she's having some problem now. So have to look for that scar and when I'm doing inspection of abdomen I'm watching like this in this position may not be able to visualize may not be able to differentiate all movements. So have to watch it from lateral position first and after that have to watch it from legged. Yes. So have to watch it from lateral side as well as from lean side. And now want to do oscultation with the help of my status. scope. want to listen to the bowel sounds and see we do not have to rush here. We have to wait because you know after every 5 to 10 seconds we can hear one bowel sound and we have to wait and suppose if we are staying there for more than 2 minutes and if we do not hear any bowel sound then we can classify it as silent bowel. I'm going to use the diaphragm of my stethoscope. also want to see is there any abdominal aneurysm. So I'm going to oscultate near to abdominal aorta. and now I'm going to perform percussion. So what exactly want to assess while doing percussion? If have to check whether there is hibtogali or spelinogali or is there any free fluid present in the peronial area and also want to check shifting of dullness. So on the basis of tempani sound and dull sound can differentiate everything. And now want to check the level of free fluid in the body. So first of all want to progress over the bladder and after that will be moving towards right side. And now I'm going to ask my patient to move to move literally. So if there is any fluid present over here, fluid is going to shift at the down part. And after that will be checking for the shifting of dullness. If there is any fluid present over there can you please stand like in lateral position. Thank you. At this point wait for some time because if there is presence of fluid it will take some time to settle down at least for 15 to 20 seconds you have to wait and after that you start your percussion again. If there is fluid then there will be shifting of dullness. And next I'm going to do palpation after percussion. Always you have to remember that we never have to palpate before we do inspection because once we start with palpation and after that there will be abnormality in the movements of abdominal muscles. So first have completed inspection and now I'm going to do palpation. So what is the meaning of palpation? I'm going to touch this segment of abdomen with my fingers and how to do it I'm going to demonstrate you here. And one mistake while doing palpation some medical do want to show you that with the help of their tip of fingers and do you think this is right way of doing palpation? It looks like you are poking the abdomen of your patient. It could be possible that patient may get hurt and after that patient will contract her abdominal muscles and after that your palpation will not have any use. So the best way how to do palpation the most important thing is that your patient should be very very comfortable. So now I'm going to demonstrate you how to do proper palpation. See there are nine quadrants in abdomen and in each and every quadrant we have to palpate and we have to check for any lump any mass. See this is the proper way of doing palpation. You are going to touch the abdomen of patient with complete hand and first we have to do superficial palpation and after that we have to do deep palpation. So what is the need of superficial palpation and deep palpation of course like we want to check out for superficial lump or mass. have to watch the face of patient. If there will be any pathology or if there will be any tenderness, patient will feel pain. And just watching the face of patient can assess the condition. Superficial palpation is completed. Now I'm going to do deep palpation so that can look for any organomegali. And while doing deep palpation also of course have to watch the face of my patient. and in this way depalpation is completed and related to palpation want to ask you one question suppose if patient is complaining that in particular segment she's having pain are you going to palpate that area in the first or you are going to palp that area and the last always remember where patient is complaining of pain that area you should not be pulpating in the beginning because like in the first of palpation if you are going to produce any tenderness there after that patient will be having pain and she may not allow you to palpate it further so the painful area should always be palpated in last and now I'm going to palpate liver and to palpate the liver always start from lower part right lower quadrant and go up. And next I'm going to palpate spleen. And palpation should always be started from right lower quadrant. And after that we have to move up. And now I'm going to palpate the kidney of my patient. Here single hand palpation will not be enough. So we have to use our both hands. And this is called as by manual examination. have completed pulpation of liver, spleen and the kidneys. Now specifically want to palpate over supracal muscles. In the same manner want to check infracal areas and for that we are having two test. One is called as raise head test and in that test I'm going to ask my patient to raise her head and when she's going to raise her head supracal muscles will be hardened and I'm going to palpate. Then if there will be any swelling or any lump at that time it will be more prominent. In this same way when want to check infracalcal muscles infracal segments I'm going to ask my patient to raise her legs at that time infracal segments will be more contracted if there will be any swelling or lumps can palpate that I'm going to ask my patient to raise her head so can you raise your head please now I'm going to palpate the infraal segments and for that I'm going to perform test and that is called as raise leg test. I'm going to ask my patient to raise her legs. After that lower abdominal muscles will be contracted and then will be pulpating that area. If there will be any lump and swelling at that time it will be more prominent. Can you please raise your legs? Heat. Heat.