■Abdominal Examination (P1)

▪︎Inspection of the Abdomen For :

•Scars
•Abdominal distension
•Visible Pulsation/Peristalisis
•Drains/Stoma
•Dressings

•Caput medusae: engorged paraumbilical veins associated with portal hypertension (e.g. liver cirrhosis).

•Striae (stretch marks): caused by ascites, intrabdominal malignancy, Cushing’s syndrome, obesity, pregnancy.

•Hernias: ask the patient to cough and observe for any protrusions through the abdominal wall.

•Cullen’s sign: bruising of the tissue surrounding the umbilicus associated with haemorrhagic pancreatitis. (Cullen Umbilicus)

•Grey-Turner’s sign: bruising in the flanks associated with haemorrhagic pancreatitis. (Grey Flank)

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■Abdominal Examination (P2)

■Palpation

▪︎Light palpation For :
•Tenderness
•Masses
•Rovsing’s sign (Appendicitis)
•Murphy’s Sign (Acute Cholecystitis)

•Rebound tenderness: when the abdominal wall compressed slowly, and released rapidly results in sudden sharp abdominal pain.

•Guarding: involuntary tension in the abdominal muscles that occurs on palpation associated with peritonitis

•Rigidity: Abdominal muscles stiffness and painful on touching induced by acute peritonitis

▪︎Deep Palpation For :
•Deeper masses.


▪︎Liver/Spleen/Kidney Palpation For :
•Enlargement
•Presence of Mass


■Percussion For :
•Ascites (Shifting dullness/Transmitted Thrills)
•Organ Percussion (Liver/Spleen/Kidneys)


■Auscultation For :
•Bowel sounds (in RLQ area of ileocaecal Valve)
•Bruits (Renal/Aortic Artery)

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■Normal Vital Signs

▪︎Blood pressure:
•Normal Range:
120-140 systolic
80-90 diastolic

•ideal blood pressure is considered to be between 90/60mmHg and 120/80mmHg

•high blood pressure is considered to be 140/90mmHg or higher

•low blood pressure is considered to be 90/60mmHg or lower



▪︎Breathing: 12 - 18 breaths per minute

▪︎Pulse (HR): 60 - 100 beats per minute

▪︎Temperature: 36.5 - 37.3 C
average 37°C

▪︎O2 Saturation: 95% - 100%

▪︎Urine output: 0.5 - 1.5 cc/kg/hour

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❇️ Features of good scar

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A Cullen’s sign (near the Umbilicus)
B Gray turner sign (at the flanks)

possibly ▶️ haemorrahgic pancreatitis.

Do Amylase or lipase blood test.

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-paraubmclical hernia
- strangulation, obstruction.

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+++

Q/ Liver span ?

It is the distance between the lower border of the liver in the mid-clavicular line obtained by palpation, and the upper border of the liver in the mid-clavicular line detected by percussion (the upper border of the liver lies behind the ribs and can not be palpated)

Normally :- (12-14) cm

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■Positions for rectal examination

▪︎Left Lateral
▪︎Knee-Elbow
▪︎lithotomy (During Surgery)

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مرجع ممتاز #للتشخيصات_التفريقية
لأعراض الباطنة والجراحة

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❇️Stigmata of Chronic Liver Disease

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