Examining the Stomach

by Noor Sash, PhD

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    00:00 look at your tummy if that’s all right next? Okay.

    00:04 So, on inspection, I’m looking for things like scars. Is there any distension? Is there any scratch marks? Is there any bruising? Bruising around the umbilicus is called Cullen’s sign, excellent. And any bruising around the flanks, so you’d have a look at both sides.

    00:20 Grey-Turner’s sign. Absolutely. So, Grey-Turner’s is associated with the retroperitoneal bleeding. So you may think of it as a triple A. It has something to do with the kidneys. Another thing to look at is potential scars that go into the flanks which might indicate -- Kidney surgery.

    00:32 Yeah. Absolutely, absolutely. I can’t see anything obvious when I’ve examined you, Tommy. So, would it be all right for me to have a very quick feel of your tummy? Yeah. Okay. It’s an important thing to get down to the patient’s level, and I’m keeping my eyes focused on the patient. Is there any sore at the moment? No.

    00:50 What would you do if there was? Start away from the area.

    00:54 Yeah, start away from them. So, I was trying to think of the light touch as you’re sort of feeling out for any areas that might be so -- okay. So I’m just going to start up here. Just tell me if anything is feeling sore. So I’m just systematically palpating all nine quadrants and having a look at the patient’s face for any signs the discomfort.

    01:13 That’s all okay, sir? Yeah, fine.

    01:16 Would it be alright for me to have a bit of a deeper feel, Tommy? This time, the deeper feel is more to feel for masses, pulsations. Is there anything else obvious that I can listen such as a deep pain when I’m palpating? Again, I’d palpate deeply at all nine quadrants.

    01:34 Things that you need to look for when you’re palpating is the pain when you’re pushing in, is it worst when you’re letting go? That gives you an idea of whether or not there’s any rebound tenderness. In terms of palpation, I’m going to move on to just have a quick feel of your kidneys if that’s okay? So you just lay back. I’m just going to slip my hand just behind your back. You relax for me. I’m just going to press back and forth.

    01:55 Is that feeling sore at all? No.

    01:56 Okay. So you’re feeling for the size of the kidney. That’s fine. And if it’s enlarged, you might feel a renal mass, but you’re also trying to feel if there’s any renal angle tenderness. Next thing I want to do is feel out for the liver. How do we do that?

    About the Lecture

    The lecture Examining the Stomach by Noor Sash, PhD is from the course The Physical Exam.

    Author of lecture Examining the Stomach

     Noor Sash, PhD

    Noor Sash, PhD

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