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Pemeriksaan Abdomen
Pemeriksaan Abdomen
General Considerations
1.
2.
3.
4.
5.
6.
7.
EXAM SECTIONS
1. Inspection
2. Auscultation
3. Percussion
4. Palpation
1. INSPECTION
Physicians locate findings in the abdomen in one of
four quadrants or one of nine regions.
The four quadrants are:
right upper (RUQ),
right lower (RLQ),
left upper (LUQ) and
left lower (LLQ).
THE NINE REGIONS
epigastric,
umbilical,
hypogastric/suprapubic,
right hypochondriac,
left hypochondriac,
right lumbar,
left lumbar,
right inguinal and
left inguinal.
ABDOMINAL DISTENSION
Distension of the lower abdomen only can be
caused by pregnancy, full bladder, ovarian tumor,
or uterine fibroids (common benign growths)
Diffuse abdominal distension can be caused by any
of the 6 Fs:
Fat (obesity)
Fluid (ascites - peritoneal fluid - or obstructed viscera
filled with fluid)
Flatus (air) - e.g. from air swallowing or intestinal
obstruction
Feces (constipation
Fetus (pregnancy)
Fatal cancer.
2. AUSCULTATION
GUT SOUNDS
3. PERCUSSION
What it finds: liver size (kind of), spleen, fluid.
Percussing the body gives one of three notes:
Tympany is found in most of the abdomen,
caused by air in the gut. It has a higher pitch
than the lung.
Resonance is found in normal lung. It is lower
pitched and hollow.
Dullness is a flat sound, without echoes. The
liver and spleen, and fluid in the peritoneum
(ascites: ah-SY-teez), give a dull note.
A. Liver Span
Percuss downward from the chest in the right midclavicular line
until you detect the top edge of liver dullness.
Percuss upward from the abdomen in the same line until you detect
the bottom edge of liver dullness.
Measure the liver span between these two points. This
measurement should be 6-12 cm in a normal adult.
B. Splenic Dullness
Percuss the lowest costal interspace in the left anterior axillary
line. This area is normally tympanitic.
Ask the patient to take a deep breath and percuss this area again.
Dullness in this area is a sign of splenic enlargement.
Shifting Dullness
This is a test for peritoneal fluid (ascites). ++
Percuss the patient's abdomen to outline areas of dullness and tympany.
Have the patient roll away from you.
Percuss and again outline areas of dullness and tympany. If the dullness has
shifted to areas of prior tympany, the patient may have excess peritoneal
fluid.
Psoas Sign
This is a test for appendicitis. ++
Place your hand above the patient's right knee.
Ask the patient to flex the right hip against resistance.
Increased abdominal pain indicates a positive psoas sign.
Obturator Sign
This is a test for appendicitis. ++
Raise the patient's right leg with the knee flexed.
Rotate the leg internally at the hip.
Increased abdominal pain indicates a positive obturator sign.
4. PALPATION
General Palpation
1. Begin with light palpation.
At this point you are mostly
looking for areas of
tenderness. The most
sensitive indicator of
tenderness is the patient's
facial expression (so watch
the patient's face, not your
hands). Voluntary or
involuntary guarding may
also be present.
2. Proceed to deep palpation
after surveying the abdomen
lightly. Try to identify
abdominal masses or areas
of deep tenderness