CLINICAL EXAMINATION OF THE ABDOMEN

Two kinds of pain:

• Visceral Pain: Deep, throbbing, delocalized pain, associated with the visceral organs.
• Somatic Pain: Sharp, piercing, pain localized to the abdominal wall.

Abdominal Medical History: (pqr)2st3
• P -- Provoking: What have you noticed that makes this pain worse?
• P -- Palliating: What relives the pain?
• Q -- Quantity: How much pain are you having?
• Q -- Quality: What does the pain feel like?
• R -- Region: Where is the pain?
• R -- Radiation: Does the pain go (radiate) to any other locale?
• S -- Severity: How does it keep them from doing what they normally would do?
• T -- 3 time related questions
o Did the pain just start (suddenly) or come on gradually?
o Is the pain constant or does it come and go?
o Is the first time you ever had this or have you noticed anything like this before?


OBSERVE:

Watch patient walk to table. Look for visible pain and discomfort. Note vital signs, stretch marks, scars, vascular
pattern, etc.

LISTEN (AUSCULTATE):

• Listen for fluid sounds -- mix of fluid and gas mixing by peristalsis.
o If you hear nothing, listen up to five minutes before concluding there are no bowel sounds. It can take a while.
• Listen for blood flow. In some slender people you can hear turbulent flow.
• Listen for Friction Rub, which occurs when inflamed organs rub next to each other.
• Listen for transmission of sounds from chest.

PERCUSSION:
Best way to examine liver is by percussion, to feel for borders. Can percuss for spleen to determine if it is
enlarged.

PALPATE:
Feel all major organs for inflammations, abnormalities, position, etc.
Four Quadrants:

• Midsagittal Plane: Vertical line going through the middle of the abdomen.
• Transumbilical Plane: Horizontal line going through the umbilicus.
• Four Quadrants based on those planes:

o Right Upper Quadrant: RUQ
o Right Lower Quadrant: RLQ
o Left Upper Quadrant: LUQ
o Left Lower Quadrant: LLQ

Nine Regions:

1. • Vertical lines of division: Left and Right Mid-Clavicular Lines

1. • Horizontal lines of division:

o Transpyloric Plane: Sometimes used. It is halfway between the jugular notch and the pubic bone.
o Subcostal Plane: Upper plane, passing through the inferior-most margin of the ribs.
o Transtubercular Plane: The line transversing the pubic tubercle.
• Divisions:
o Upper: Right Hypochondriac, Epigastric, Left Hypochondriac
o Middle: Right Lumbar, Umbilical, Left Lumbar
o Lower: Right Inguinal, Hypogastric (Suprapubic), Left Inguinal

Category: Anatomy Notes