4 Palpation of masses the masses of abdomen

4. Palpation of masses the masses of abdomen may be caused by enlarged organ ectopic organ cyst carcinoma inflammatory tissues enlarged lymphnode

(1)Normal masses of abdomen tendon of abdominal rectus lumber vertebral body sacral promontory sigmoid colon transverse colon cecum

(2). Abnormal mass of abdomen when you palpate the mass of abdomen you should describe the location size contour consistency tenderness pulsation mobility

The location of mass The mass usually originate from located organ, where you find a mass where the organ has lesion. If the location of mass is variable, the mass may originate from omentum, mesentery, or with stalk.

big mass without intestinal obstruction, the mass originate from mesentery peritoneum omentum postperitoneum

The size of mass The mass should be measured with a ruler to see how big it is, but sometimes the measurement is difficult, such as deep mass, small mass so you can estimate the size of mass, comparing with something like peanut, bean, egg, fist, baby`s head and so on.

Big mass usually indicate cyst such as ovarian cyst, hepatic cyst or polycystic kidney. Intestinal tumor usually accompanied with intestinal obstruction. Mass with variable size indicates spasm of intestinal segment.

The contour of mass the outline of mass is clear or not ※ the surface is smooth or not ※ the margin is sharp or blunt ※ round and smooth mass indicate a cyst ※

Irregular, nodular, hard mass indicate malignant tumor ※ A soft cystic mass in right hypochondrial region indicate distended gallbladder ※ A mass with notch in left upper quadrant indicate splenomegaly ※

The consistency of mass soft mass cyst, abscess ※ middle hard inflammatory mass ※ hard tumor ※ the tenderness of mass severe tenderness inflammatory mass ※ light tenderness tumor ※

The pulsation of mass abdominal aneurysm or a mass next to the aorta enlargement of liver with pulsation tricuspid valve incompetence

The mobility of mass a mass move with respiration it maybe from liver, spleen, stomach, kidney, gallbladder or transverse colon ※ a mass can be moved with hand it may be from stomach, intestine or mesentery ※

A mass can be moved easily and widely it may be from a tumor with a stalk wandering kidney wandering spleen ※ A mass can not be moved it may be from postperitoneal or inflammatory mass ※

5. Fluid wave thrill with the patient in supine position, the examiner’s left hand is placed on the patient’ s right flank, an assistant (another person) places one hand on the middle of the abdomen to prevent the transmission of any wave through the tissues of the abdominal wall

The examiners’s right hand then lightly taps the left flank of the patient, in the presence of a significant amount of ascites, a wave will be transmitted through the fluid to the examiner’s left hand as a sharp impulse.

6. Succussion splash

Succussion splash this examining method can check for retention of gastric fluid. If succussion splash is positive after meal 6 -8 hours indicating pyloric obstruction

Percussion

Percussion can check for the presence of abdominal distention, tumor, fluid, enlargement of viscera. percussion tone of abdomen liver spleen dullness flatness remains tympany.

Percussion of liver --upper margin

Percussion of liver --lower margin

normal liver upper limit 5 th intercostal space lower border --costal margin diameter of dullness 9 -11 cm enlargement of liver dullness hepatitis, hepatic carcinoma hepatic cyst hepatic abscess hepatic engorgement

Decreased liver dullness cirrhosis of liver, hepatonecrosis absence of liver dullness perforation of hollow viscus interposition of hepatic flexure of the colon. percussive pain of liver hepatitis hepatic abscess percussive pain of the gallbladder cholecystitis

Percussion of spleen normal left midaxillary line 9 th – 11 th intercostal space width 4 -7 cm enlargement of splenic dullness: splenomegaly

traube area tympanitic area of stomach

Percussion of ascites shifting dullness >1000 ml elbow-knee position check for small amount ascites

Auscultation

bowel sound normal 4 -5 times /min increased >10 times acute intestinitis, loud high-pitched tinkling quality: intestinal obstruction decreased or disappeared: acute peritonitis, intestinal paralysis, electrolyte disorder

vascular bruit systolic bruit partial occlusion of renal artery above umbilicus left or right side hepatic cancer lesion area abdominal aneurysm or partial occlusion of abdominal aorta

Vein bruit periumbilicus, upper abdomen or over the liver: continuous humming sound, seen in portal hypertension caused by cirrhosis of liver Friction rub over the spleen or over the liver perisplenitis caused by spleen infarction perihepatitis