Quick Review: Examination of the Abdominal Region

by Stephen Holt, MD, MS

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    00:01 Okay, let's review the content that we've learned during this lecture.

    00:06 Alright, so this is a busy slide.

    00:07 And I'm just going to hone in on one or two findings as we go through each row.

    00:12 With cholecyctitis there's that classic Murphy's sign where you're having the patient take a deep breath while you're pushing in the area and the right upper quadrant.

    00:21 Patients with cirrhosis have a variety of manifestations, so called stigmata of liver disease, but perhaps one of the most significant ones to look for is ascites on the exam.

    00:32 Palmar erythema and telangiectasia or spider angioma over the chest wall are also very useful findings.

    00:40 Gastric ulcer.

    00:41 If you're looking for just pain in the epigastrium patients with appendicitis will classically have a McBurney's point and perhaps a positive Psoas Sign with diverticulitis over in the left lower quadrant you're simply looking with pain, with palpation.

    00:56 With bowel obstruction, you may have diffuse tympany on the abdomen and potentially some high pitched noises on auscultation of the abdomen.

    01:05 And then with acute peritonitis, you're looking for diffuse discomfort on the abdomen, as well as rigidity which is involuntary.

    01:12 You can't get the patient to relax when somebody has acute peritonitis, which of course can be a surgical emergency.

    01:19 So the stigmata of cirrhosis include each of the following except bulging flanks, pedal edema, palmar erythema, Terry's nails, or a positive Carnett's sign.

    01:37 Well, each of those first four things that are mentioned there are characteristic of patients with advanced liver disease and contrast a positive Carnett's sign would indicate not intra-abdominal problems but instead an abdominal wall cause for the patient's discomfort.

    01:55 The findings associated with acute appendicitis include each of the following except: Castell's sign, Psoas sign, the Obturator sign, McBurney's sign or McBurney's point, or rebound tenderness.

    02:14 So Castell's sign is referring to patients with splenomegaly over at Castell's point at the bottom of the Traube's space, so that's not really a feature of acute appendicitis.

    02:25 In contrast, with acute appendicitis, you may see Psoas sign, or its accompanying Obturator sign, you may see pain over McBurney's point so called McBurney's sign, and you certainly may see rebound tenderness, particularly in patients who have a perforated appendix.

    About the Lecture

    The lecture Quick Review: Examination of the Abdominal Region by Stephen Holt, MD, MS is from the course Examination of the Abdominal Region.

    Author of lecture Quick Review: Examination of the Abdominal Region

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

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