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ACUTE ABDOMEN Part 02 : Physical Exam

ACUTE ABDOMEN : Physical Exam

steps in physical exam


1) general observation: patient position (i.e. lying still vs. writhing)
2)vitals: postural changes, fever
3)status of hydration
4)cardiovascular/respiratory examination
5)abdominal examination

  • observation: distention, scars, visible peristalsis
  • auscultation: absent, decreased, normal, increased bowel sounds
  • percussion: hypertympanic sounds in bowel obstruction,percussion tenderness indicative of peritonitis
  • palpation: tenderness, abdominal masses


6)  CVA tenderness
7)  specific signs
8)hernias, male genitalia
9)rectal/pelvic exam

 

Labs

  1. CBC and differential
  2. electrolytes, BUN, creatinine
  3. amylase levels
  4. liver function tests
  5. urinalysis
  6. stool for occult blood
  7. others as indicated
  8. ECG, fl-hCG, ABG, septic workup, lactate (ischemic bowel) 

 

Radiology

  1. 3 views abdomen
  2. CXR
  3. others as indicated  : U/S, CT, endoscopy, IVP, peritoneal lavage, laparoscopy 

 

Indications for urgent operation


physical findings

  1. peritonitis
  2. severe or increasing localized tenderness
  3. progressive distension
  4. tender mass with fever or hypotension (abscess)
  5. septicemia and abdominal findings
  6. bleeding and abdominal findings
  7. suspected bowel ischemia (acidosis, fever, tachycardia)
  8. deterioration on conservative treatment

radiologic

  1. free air
  2. massive bowel distention (colon > 12 cm)
  3. space occupying lesion with fever

endoscopic

  1. perforation
  2. uncontrollable bleeding

paracentesis

  1. blood, pus, bile, feces, urine
ACUTE ABDOMEN Part 02 : Physical Exam ACUTE ABDOMEN  Part 02 : Physical Exam Reviewed by Radiology Madeeasy on September 03, 2010 Rating: 5
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