Local examination in acute abdomen
These included the following items 1- inspection 2- palpation3- percussion 4- ausculation5-rectal examination 6- vaginal examination first we star by inspection the patient should be lie flat on his back with the body fully exposed from nipples above to mid thighs below 1- contour we note any asymmetry distension or visible swelling if there is any asymmetry make sure it is not due to faulty posture or disease of the spine
distension of the abdomen may be central as in small intestine obstruction or peripheral as in colonic obstruction or localized as in abdominal swelling or distended stomach caecum or sigmoid loop if there is a visible swelling note it is characters whether it is intraabdominal or extra abdominal this by asking the patient to contract his abdominal wall by raise the head and shoulders off the bed if the swelling becomes more prominent it must be superficial to the muscles (extra abdominal)but if it disappears or becomes less prominent so it must be deep to them (intraabdominal then ask the patient to breathe deeply and watch the movement of the tumour during inspiration and expiration an intraabdominal swelling moves longitudinally up and down with
respiration whereas an extra abdominal swelling moves forwards and backwards with the abdominal wall 2- hernial orifices inspect the umbilicus and groins for any visible swelling or expansile impulse on coughing 3- skin note any abrasions or bruises suggesting injury to the abdomen in case of acute pancreatitis patches of bluish dis colouration may be observed in the loins (Grey-Turner,s sign) or around the umbilicus (Cullen,s sign)in herpes zoster the characteristic vesicles establish the diagnosis at once 4- visible movements which either respiratory movements or peristaltic movements or pulsations 1- respiratory movements in normal quit respiration the anterior abdominal wall moves forwards on inspiration owing to descent of the diaphragm so loss of respiratory movements indicates reflexes spasm of the abdominal wall due to sever peritoneal irritation and is known clinically as abdominal rigidity it is best diagnosed by inspection not by palpation the rigidity may be localized over an inflamed organ or to one quadrant or may affect the upper or lower abdomen (spreading peritonitis)or the whole abdomen (generalized peritonitis)in some case the spasm may be so sever as in perforated peptic ulcer that the abdominal muscles can be seen standing out (board like rigidity) you must remember that all causes of true rigidity require urgent operation 2- peristaltic movements watch carefully for visible peristalsis in pyloric stenosis or obstruction gastric peristalsis shows as a round swelling moving from left to right across the upper abdomen in small intestinal obstruction the peristalsis classically show it self as the (the ladder pattern)extending from te left upper abdomen towards the right iliac fossa large bowel peristalsis is rarely visible it should be realized that visible peristalsis is not always pathological because in thin person like female and olderly male 3- pulsations rarely the acute abdominal pain is due to a leaking abdominal aneurysm
These included the following items 1- inspection 2- palpation3- percussion 4- ausculation5-rectal examination 6- vaginal examination first we star by inspection the patient should be lie flat on his back with the body fully exposed from nipples above to mid thighs below 1- contour we note any asymmetry distension or visible swelling if there is any asymmetry make sure it is not due to faulty posture or disease of the spine
distension of the abdomen may be central as in small intestine obstruction or peripheral as in colonic obstruction or localized as in abdominal swelling or distended stomach caecum or sigmoid loop if there is a visible swelling note it is characters whether it is intraabdominal or extra abdominal this by asking the patient to contract his abdominal wall by raise the head and shoulders off the bed if the swelling becomes more prominent it must be superficial to the muscles (extra abdominal)but if it disappears or becomes less prominent so it must be deep to them (intraabdominal then ask the patient to breathe deeply and watch the movement of the tumour during inspiration and expiration an intraabdominal swelling moves longitudinally up and down with
respiration whereas an extra abdominal swelling moves forwards and backwards with the abdominal wall 2- hernial orifices inspect the umbilicus and groins for any visible swelling or expansile impulse on coughing 3- skin note any abrasions or bruises suggesting injury to the abdomen in case of acute pancreatitis patches of bluish dis colouration may be observed in the loins (Grey-Turner,s sign) or around the umbilicus (Cullen,s sign)in herpes zoster the characteristic vesicles establish the diagnosis at once 4- visible movements which either respiratory movements or peristaltic movements or pulsations 1- respiratory movements in normal quit respiration the anterior abdominal wall moves forwards on inspiration owing to descent of the diaphragm so loss of respiratory movements indicates reflexes spasm of the abdominal wall due to sever peritoneal irritation and is known clinically as abdominal rigidity it is best diagnosed by inspection not by palpation the rigidity may be localized over an inflamed organ or to one quadrant or may affect the upper or lower abdomen (spreading peritonitis)or the whole abdomen (generalized peritonitis)in some case the spasm may be so sever as in perforated peptic ulcer that the abdominal muscles can be seen standing out (board like rigidity) you must remember that all causes of true rigidity require urgent operation 2- peristaltic movements watch carefully for visible peristalsis in pyloric stenosis or obstruction gastric peristalsis shows as a round swelling moving from left to right across the upper abdomen in small intestinal obstruction the peristalsis classically show it self as the (the ladder pattern)extending from te left upper abdomen towards the right iliac fossa large bowel peristalsis is rarely visible it should be realized that visible peristalsis is not always pathological because in thin person like female and olderly male 3- pulsations rarely the acute abdominal pain is due to a leaking abdominal aneurysm
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