Download Abdominal

The Physical
Examination of Abdomen
The First Affiliated Hospital
of Liaoning Medical College
Liu Baihai
第一节:Abdominal landmarks & Area
一、 Abdominal landmarks
Abdominal Mark
Midabdominal
Upper
abdominal angle
Xiphoid process
line
Costal margin
umbilicus
Lateral border of
rectus muscles
Anterior
superior iliac
spine
Inguinal
ligament
xiphoid process
腹中线
midabdominal line
costal margin
Lateral border of rectus muscle
umbilicus
Anterior superior iliac
spine
腹股沟韧带
耻骨上缘
superior margin of os pubis
inguinal ligament
二、Abdominal Area
four quadrants system
right upper
quadrant
right lower
quadrant
left upper
quadrant
Left lower
quadrant
Right upper quadrant
liver
gallbladder
pylorus
duodenum
pancreas(head)
right kidney
hepatic flexure of colon
Right lower quadrant
cecum
appendix
ascending colon
small intestine
right ovary and
tube
Left upper quadrant
liver (left lobe )
spleen
stomach
pancreas
(body tail)
left kidney
splenic flexure of colon
Left lower quadrant
sigmoid colon
descending colon
small intestine
left ovary and tube
Nine regions system
right lumber region
right iliac region
epigastric
region
umbilieal
region
hypogastric
region
left hypochondriac
region
left lumber region
left iliac region
Abdominal Area:
Nine regions
right hypochondriac
region
stomach
gallbladder
ascending
colon
transverse
colon
small
intestine
ileum
sigmoid
colon
urinary bladder
Nine regions &
Projection
spleen
Regions
right & left
hypochondrial
right & left lumber
right & left iliac
epigastric
umbilical
hypogastric
Right hypochondrial
liver gallbladder
right kidney
hepatic flexure of colon
right lumber
ascending colon jejunum
right kidney
right iliac
cecum appendix
right ovary and tube
Epigastric
liver (left lobe) pylorus
duodenum omentum
transverse colon
the head and body of pancreas
umbilical
duodenum jejunum ileum
mesentery abdominal aorta
lymph node omentum
hypogastric
bladder womb ureter
Left hypochondrial
spleen stomach
splenic flexure of colon
pancreas (tail part )
left kidney
left lumber
descending colon
jejunum ileum
left iliac
sigmoid colon
left ovary and tube
Right upper
abdominal region
Left upper
abdominal region
Umbilieal region
Right lower
abdominal region
Left lower
abdominal region
Hypogastric
region
Abdominal Area:
Seven regions
Epigastric
region
Inspection
The major contents of inspection






abdominal contour
respiratory movements
abdominal veins
gastral or intestinal pattern(胃型或肠型)
peristalsis(蠕动波)
abdominal rash, hernia(疝), striae(纹), etc.

Normal
√abdominal flatness(腹部平坦)
√ abdominal fullness(腹部饱满)
√ abdominal lowness(腹部低平
1. Abdominal contour
1. Abdominal contour
in healthy person abdomen is usually
flat from xiphoid to symphysis pubis ,
we call abdominal flat or even
abdomen. the umbilicus is located in
the abdominal center. depending on
the nutritional status, the abdominal
contour may be lightly protuberant or
scaphoid.
Abdominal bulge
generalized abdominal bulge is
usually caused by ascites
some causes for ascites:
heart failure
cirrhosis of liver
nephrotic syndrome
TB peritonitis

Overall abdominal bulge can be caused
by several pathological factors besides
overly obesity or physiological
pregnancy. In obesity and fat, the umbilicus is
usually deeply inverted.

Peritoneal fluid
If there is a large amount of free fluid
within the abdomen, i, e. ascites, abdominal
wall can be lax in supine position, fluid can
deposit at both lateral sides, the contour just
like a frog belly.
The characteristic appearance of gross ascites

Apical belly尖腹
Apical belly is caused by peritonitis or
infiltration of cancers, and hence abdominal
muscle is tense, usu. with the apical shape.
Peritoneal air 腹腔积气


Peritoneal air is caused by a large amount of air
accumulating in the cavity of stomach.
√ If you ask the patient to move or change the
position, the shape of abdomen remains globular.
√ This is commonly found in intestinal
obstruction or enteroparalysis(肠麻痹).

Pneumoperitoneum气腹
√ Pneumoperitoneum is caused by air
accumulating in the abdominal cavity.
√ It is commonly found in perforation of
gastrointestinal diseases or artificial
pneumoperitoneum meant to treat.

Huge abdominal enclosed mass
腹内巨大包块
Huge abdominal enclosed mass is usually
found in full-term pregnancy, huge ovarian
cyst(卵巢囊肿), teratoma, etc.

Local abdominal bulge局部膨隆
Local abdominal bulge is usually caused by
enlarged viscera, tumor, inflammatory
enclosed mass, gastrointestinal flatulence(肠
胃胀气), hernia, etc.
Abdominal concavity/ retraction 腹部
凹陷

Overall abdominal concavity/retraction
全腹凹陷
Overall abdominal retraction is usually
found in patients severely emaciated or
seriously dehydrated.

Scaphoid abdomen舟状腹
√Scaphoid abdomen is so called because the
contour of abdomen is shaped like a boat, with
the anterior abdomen almost approximating to
spinal column .
√ This sign is commonly seen in cachexia(恶病质).

Local abdominal retraction
局部凹陷
Local abdominal retraction is caused by the
contraction of scar after operation and is less
common.
2. Respiratory movement
the manner of breathing: in men and
children, manner of breathing is
abdominal respiration. But in women the
manner of breathing is thoracic
respiration.
In some diseases such as perforation
because acute peritonitis, the respiratory
movement is limited or disappear.
2. 呼吸运动
正常表现：男性、小儿：腹式为主。
女性：胸式为主。
病理状态：腹式受限—腹部炎症、包块、
积液、膈肌麻痹。
腹式增强—癔症性呼吸、胸部疾病。
3. Abdominal veins
in healthy person abdominal vein
can not be seen or or can be seen a
little in thin person, but not dilated,
in patient with obstruction of the
portal venous system or in the vena
cava,You may find distended veins.
when you find distended veins on the abdomen
you should ascertain the direction of flow. the
normal direction of flow is away from the
umbilicus , that is the upper abdominal veins
carry blood up ward to the superior vena cava.
And the lower abdominal veins flow downward
to the inferior vena cava.
腹壁静脉及其血流方向
上腔静脉阻塞: 向下
下腔静脉阻塞: 向上
门静脉阻塞: 脐为中心,放射状,
水母头(caput medusae)。
how to ascertain the direction of
blood flow you can choice a segment
of vein, then the vein is
emptied between two fingers to a
distance of a few centimeters, then
allows blood to refill the vein from one
direction by removing one
compressing finger
Gastric or intestinal pattern(胃型或肠
型) and peristalsis(蠕动波)
in healthy person peristalsis is not visible, but in
patient with pyloric or intestinal obstruction you can
see peristalsis, in pyloric obstruction on epigastrium
the peristalsis is from left costal margin to right, in
intestinal obstruction you can see peristalsis around
umbilicus the direction of peristalsis is irregular.
胃肠型和蠕动波
gastric or intestinal pattern and
peristalsis
正常人：见于经产妇与消瘦腹壁松软者。
幽门梗阻：上腹部逆蠕动。
小肠梗阻：不规则隆起，此起彼伏。
结肠梗阻：全腹膨隆、宽大肠型。
5. The skin of abdomen
(1) skin Rash
in some diseases especially
infectious disease such as
typhoid fever you can find
roseolas on the skin of abdomen.
部位、形态、色彩、时间等。
(2) Pigment
in normal condition, the pigment of
abdomen is more decreased than
exposed part of skin, in patient with
chronic adrenocortical hypofunction
also called addison’ s disease.
Cullen sign

A bluish discoloration of the umbilicus occasionally
is seen after major intraperitoneal hemorrhage.
Turner’s sign

a bluish discoloration of the flanks. these
two signs may occur as the result of
hemoperitoneum such as hemorrhagic
pancreatitis
broken of ectopic pregnancy.
(3) Striae
silver striae distribute on the lower quadrants of
abdomen or iliac regions, it is seen after a large
gain of weight or after pregnancy. bluish striae
(purple) distribute on lower quadrants of abdomen
upper legs or hips this is found in hypercortisolism.
(4) Scar
when you find a operation scar on the
patient abdomen, you should ask some
question about the scar, when and why
the patient got the scar, the history of
operation may be helpful to diagnosis of
the disease
(5). Hernia
umbilical hernia may be seen in belly or
patient with a massive ascites .
incisional hernia operation
scar.
femoral hernia mainly seen in female.
inquinal hernia mainly seen in male.
(6) Hair distribution
in female the pubic hair is roughly
triangular with the base above the
symphysis. where as in male it is in
the shape of a diamond often with
hair continuing to the umbilicus,
the distribution and quantity of hair
maybe changed by chronic liver
disease and endocrine abnormalities
(7). Epigastric pulsation
may be seen in the following
condition:
(1). thin person
(2). Right ventricular
hypertrophy COPD
(3). Abdominal aneurysm