Inspection of the abdomen Exposure from nipple till

Inspection of the abdomen Exposure from nipple till mid thigh. lnspection from 3 different planes.

1. abdominal contour Normal abdominal contour: - Gently convex from side to side & from above downwards lf there is bulge: - Localized bulge: (Site, size, shape, number, movement with respiration, intra, or extra abdominal by asking the patient to rise up without support)

1. abdominal contour -Generalized bulge: Fluid(Ascites), fat(obesity ) , Flatus (distension ) , Fibroid or large abdominal tumor or Fetus (pregnancy). - Retraction : T. B peritonitis (dry type).

2. Movement with respiration 1. Normal: freely mobile 2. Decreased or absent: in v Rigidity: due to peritonitis v Diaphragmatic paralysis v. Abdominal distension with Ascites

3. Intistinal movement visible - Pyloric obstruction: from left to right in epigastrium - Small intestinal obstruction : (step ladder) - Colonic obstruction : (horse-shoe crossing the midline from Rt. to Lt. )

4. Epigastric pulsation Aortic aneurysm, Rt. Ventricular enlargement, pulsating liver.

5. Subcostal angle Normal 70 -90 Increase in upper abdominal swelling

6. Divercation of recti Ask the patient to rise up without support separation of two recti forming a gap which you can put the tip of finger easily: it is due to chronic increase of intarabdmoinal pressure

7. Umblicus Position: normal midway between symphysis pubis & xiphi-sternum Shape: - lnverted (normal), - Everted (chronic increase in intra-abdominal pr. ( umbilical hernia). - Deep ) obesity. Nodule : sister Joseph.

7. Umblicus frorm patent urachus. ( urine) from patent vetello-intestinal duct. (stool) from pilonidal sinus. (pus)

8. skin Ø Scar : (operation, cautery) Ø Stria : (Ascites, pregnancy, obesity, Cushing $) Scratch marks ) (obstructive jaundice) Ø Pigmentation : (Cullen sign, Grey Turner sign) Ø Petechie, ecchymosis. Ø Hair distribution: feminine (apex down) ( CLD)

9. Dilated veins Ø Gaput medusa Around the umbilicus milking test : Away from the umbilicus Ø IVC obstruction Mainlv at flanks milking test : From below upwards

10. Hernial orifices : Epigastric, paraumbilical, inguinal, femoral, incisional 11. Externa genitalia : (eg) Scrotum (ant, post aspect)Shape, symmetry and swelling Back of the scrotum for T. B sinus

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