ppt课件-abdominal exam- ohio university（腹部检查,俄亥俄大学）.pptVIP

* Liver more than 2-3 cm below costal margin may be sign of enlargement An enlarged spleen expands anteriorly, downward, and medially, often replacing the tympany of the stomach and colon with the dullness of a solid organ? then moves below the costal margin Tympany: musical note of higher pitch than resonance – air filled space Hyperesonance: lies between tympany and resonance – base of left lung Resonance: moderate pitch – lung tissue or over abdomen Dullness: short high itch note with little resonance – solid organ * * Spleen Between 9th - 11th ribs Does not extend inferior to the left costal margin * Spleen Between 9th - 11th ribs Does not extend inferior to the left costal margin * * * Liver Lied deep to ribs 7 through 11 and crosses midline to left nipple Sharp inferior border follows right costal margin More inferior when erect Inspire deeply and may palpate Place left hand posteriorly between right 12th rib and iliac crest then place right hand on right upper quadrant - pt takes a deep breath Gallbladder – Murphy’s sign * * * * * * * Winter Quarter 2010 Adapted from previous years by Amanda Kocoloski, OMS IV Abdominal Exam Agenda History Anatomy Physical Practice cases 2 gastrointestinal complaints Work on incorporating GI into history and physical exam skills Practice documentation History Common Complaints: Abdominal pain Change in appetite Dysphagia/Odynophagia Difficult or painful swallowing Nausea/Vomiting Jaundice Change in bowel habits Melena/Hematochezia Dark tarry or red stools Hemorrhoids Anal pruritis * 0 Anatomy Regions (Anatomical) Quadrants (Clinical) * 0 Surface Anatomy 0 * Enhancing the Exam Empty bladder Patient comfort (pillows and draping) Arms at side or crossed over chest Ask the patient to point to any painful areas; examine last Warm hands and stethoscope Ticklish or nervous patients: slow movements, distraction, use their hands * Exam Order Inspection Auscultation Percussion or palpation can alter bowel sound frequency Bonus Qu