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1、PhysicalExaminationof theAbdomenand MaleGenitalOrganTheAbdomenExtendsfromxiphoidprocesstothesymphysispubisRectusabdominisInternalandexternalobliquesLineaalbaInguinalligamentContainsvitalorgansMajorAbdominalOrgansQuadrantsoftheabdomenSegmentsoftheabdomenmid-clavicularlinesu
2、bcostalplaneanteriorsuperioriliacspineLocalizationofVisceralPainExaminationoftheAbdomenGoodlightandadequateexposure(xiphoidprocesstosymphysispubis,groinvisible)RelaxedpatientPatientsupine,armsatside,kneesslightlyflexedEmptybladderExaminationoftheAbdomenAskpatienttopointtoa
3、nyareaofpainExaminenon-painfulsidefirst“Visualize”underlyinganatomyWatchpatient’sfaceforsignsofdiscomfortduringtheexaminationPhysicalExaminationSequence:--Inspection--Auscultation--Percussion--PalpationInspectionoftheAbdomenSkin:color,ecchymosis,rashes,lesions,striae,scars
4、,dilatedveinsContours:flat,roundedscaphoid,protuberantSymmetry:distentionlocalbulgesInspectionoftheAbdomenUmbilicus:locationdisplacementinflammationMusculature:massesherniaseparationSurfacemotion:peristalsispulsationsAuscultationoftheAbdomenBowelsoundswarmeddiaphragmallqua
5、drantsfrequencyandcharacterclicksandgurgles,borborygmanormoactive:5-34perminute5continuousminutestoestablishabsenceAuscultationoftheAbdomenVascularsounds--Bruitswarmedbelloveraorta,renal,iliac,andfemoralarteriesoverliver(HCCoracutealcoholichepatitis)--Venoushumswarmedbello
6、verepigastricandperiumbilicalarea(increasedcollateralcirculationbetweenportalandsystemicvenoussystemsFrictionrubsoverliverandspleen(perihepatitisorperisplenitis)PercussionoftheAbdomenTodetectfluid,air,andfluid-filledorsolidmassesStomachandintestinestympany(lowerpitchedfors
7、tomach–leftloweranteriorribcageandleftepigastricarea)Organsandsolidmasses:dullnessPercussallquadrantsfordistributionoftympanyanddullness:tympanypredominatesPercussion:LiverLiverspan--rightmiddleclavicularline--fromtympanytodullness,thenfromresonancetodullness--6-12cmPercus
8、sion:Spleen--posteriortoleftMALsmallareaofdullnessfrom6thto10thribs--lowestICS(9th)inleft
