1. The Physical Examination of Abdomen 2nd Affiliated Hospital China Medical University

2. Auscultation

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

4. 2.vascular bruit systolic bruit abdominal aneurysm or partial occlusion of abdominal aorta partial occlusion of renal artery above umbilicus left or right side (hypertension) hepatic cancer (lesion area)

5. Vein bruit periumbilicus, upper abdomen or over the liver: continuous humming sound, seen in portal hypertension caused by cirrhosis of liver 3.Friction rub over the spleen or over the liver perisplenitis caused by spleen infarction perihepatitis

6. 4. Scratch sound
exploration of hepatic lower edge ， auscultary scratch The Liver scratch test uses auscultation to detect the differences in sound transmission through the abdominal cavity over solid and hollow organs and spaces After placing a stethoscope over the approximate location of a patient's liver, a medical professional will then scratch the skin of the patient's abdomen lightly, moving laterally along the liver border. When the liver is encountered, the scratching sound heard in the stethoscope will increase significantly. In this manner, the size and shape of a patient's liver can be ascertained.

7. 5.Puddle test
exploration of small quantity of ascites (elbow—knee position)about 120 ml
1. Patient lies prone for 5 minutes
2. Patient then rises onto elbows and knees
3. Apply stethoscope diaphragm to most dependent abdomen
4. Examiner repeatedly flicks near flank with finger. Continue to flick at same spot on abdomen
5. Move stethoscope across abdomen away from examiner
6. Sound loudness decreases at farther edge of puddle
7. Sound transmission does not change when patient sits

9. Percussion can check for the presence of abdominal distention, tumor, fluid, enlargement of viscera. 1.percussion tone of abdomen liver spleen dullness flatness remains tympany

10. 2. Percussion of liver --upper margin

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

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

13. 3.traube area tympanitic area of stomach

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

15. differentiate massive ovariocyst from ascites ovariocyst ★dullness location center abdomen ★ no shifting dullness ★ ruler pressing test (＋)

16. 6.percussion of bladder distended bladder dullness disappear after urination 7.Percussion of kidney (costovertebral angle) percusive pain of kidney glomerulonephritis pyelothiasis perirenal abscess

18. Palpation --------the most important method in examination of abdomen.

19. The preparation of patient: with the patient in supine position, the head should be elevated on a pillow, patient’s arms relax at the two sides of the body, flex his thighs and knees, relax his abdominal muscles

20. According to different parts and organs of examination, the patient can be in right lateral decubitus position such as the examination of spleen, standing position such as the examination of kidney.

21. The position of doctor the doctor stands at the right side of patient, warm hands, using your palmar aspect of fingers, examining gently and lightly from superficial to deep, and from healthy part to lesion area.

22. The sequence of palpation usually the sequence of palpation is contraclock direction: left lower left lumber left upper epigastric right upper right lumber right lower hypogastric umbilical.

23. the sequence of palpation

24. 1、浅部触诊法 （light palpation） 2、深部触诊法 （deep palpation）
The palpating methods
1、浅部触诊法 （light palpation）
2、深部触诊法 （deep palpation）
(1).深压触诊法 （deep press palpation）(2).深部滑行法（deep slipping palpation） (3).双手触诊法 （bimanual palpation） (4).冲击触诊法 （ballottement）

25. The contents of palpation 1. abdominal muscles tensity 2
The contents of palpation 1.abdominal muscles tensity 2.tenderness and rebound tenderness 3.abdominal organs 4.abdominal masses 5.fluid thrill 6.succussion splash

26. 2.Tenderness and rebound tenderness usually caused by inflammation, carcinoma and TB. The part of tenderness is usually the location of lesion. for example, tenderness in right upper abdomen: hepatitis cholecystitis.

27. Lumber region kidney stone right lower abdomen appendicitis epigastria region peptic ulcer umbilical small intestine diseases ascariasis rebound tenderness when inflammation involve parietal peritoneum such as acute peritonitis, acute appendicitis. the rebound tenderness is positive