Exploración Abdominal

This video will be about an

abdominal examination. It's worth mentioning

that the doctor usually stands

on the patient's right side to

perform the

examination. In this particular case,

we use a quadrant division,

although a

nine-

region division can be used. In the first quadrant, the

upper right quadrant, you'll find

the liver, gallbladder, head of the

pancreas, part of the right kidney,

right adrenal gland, and parts of the

digestive tract, including the hepatic flexure

of the colon. There's also the

upper left quadrant, where you'll find the

spleen, left lobe of the liver, body

and tail of the pancreas, part of the

left kidney, left adrenal gland, and

parts of the digestive tract, including the

splenic flexure of the colon.

Similarly, there's the lower right quadrant,

where you'll find the

cecum and appendix, right ovary and fallopian tube,

lower pole of the right kidney and ureter, and

other parts of the

digestive tract such as the ascending colon and

inguinal canal. In the lower

left quadrant, you'll find the

sigmoid colon and part of the descending colon, left ovary

and fallopian tube, lower pole

of the left kidney and ureter, along with

the left inguinal canal. Let's

begin the video with inspection,

followed by auscultation, percussion, and

finally palpation with its specific techniques. Thank

you very much. The first step in the

abdominal examination is inspection.

We'll first check the shape of the

abdomen. In this case, the patient has

a flat abdomen. Next, we'll check if

the patient has any scars or

lesions. In this case, everything is normal, without any

abnormalities. A

supraumbilical spot may be present, but in this patient, it

's completely normal. Next, we'll

check the respiratory movements. The

patient's breathing is

symmetrical and doesn't appear to have any

abnormalities. Next, we'll check the

navel, which has a normal scar. No

secretion or scarring is observed.

From there, we can proceed to the

pubic hair, which has a

normal distribution. Finally,

we'll talk

about dilated veins, which can be

normal, but they are not noticeable in this patient.

And lastly,

if the patient remains still,

you can feel the palpitations of

the abdominal wall. In this case, it's not

very prominent, but it also doesn't present

any

abnormalities. Let's proceed to

auscultation. It is very

important that we perform this before

palpation and percussion so as not to alter

the bowel sounds. We have the

normal sounds, which are borborygmi

or bowel sounds, and we can also

have pathological sounds such as rubs or

friction rubs. Next, I am going to proceed to

auscultate the patient in the different

quadrants. We can perform a maneuver

to desensitize the

patient, which is what I am doing

at this

moment. Now we are going to place the

stethoscope, which may be a little cold.

It is important to know that

bowel sounds have a frequency of 5

to 35 per minute. Next,

we proceeded to auscultate the aorta, the

renal arteries, and the femoral arteries. It is very

important that we do this with the bell

of the stethoscope, unlike the

rest of the auscultation, which was done with the

diaphragm. I am going to start with the aorta at the

supraumbilical level,

renal arteries,

femoral arteries. Well, in the case of this

patient, we did not find any

abnormal sounds when auscultating the different

arteries. During the

auscultation, a maneuver to To delineate

organs, in this case I'm going to do it

on the liver, but we can also

do it on the

spleen. We'll start by placing the

stethoscope and scratching here. We

can already delineate the

lower lobe. We

scratch the left lobe, then

scratch the upper lobe again, and finally the

right lobe. To proceed with percussion, we'll

use the pleximeter hand and the

pleural hand. Preferably, we'll use the

middle finger with the

distal phalanx and percuss on the

second phalanx of any

of the five fingers that will be

positioned with the pleural hand. We'll

proceed in this

way. With this, we'll be able to detect

if there is inflammation,

intestinal obstructions, a pregnant uterus, or any

tumor in the abdomen.

As you can see in this

patient, it sounds predominantly

tympanic over this area, which indicates

that it's an

empty intestine or one full of air.

To proceed with percussion, we'll

use the pleximeter hand and the pleural hand.

The hand will be positioned as follows: the hand will be

percussed with the distal phalanx of the

middle finger on the second phalanx

of any of the fingers of the other

hand.

This is used to evaluate all

three quadrants of the abdomen. For the special

percussion techniques, the

liver and the spleen will be evaluated

respectively.

The hand will be positioned on the right quadrant

to evaluate the liver, and

percussion will begin to delimit

the areas of the liver. It is important to

note that the liver measures 6 to

12 cm in the midclavicular line

and 4 to 8 cm in the

external midline. To percuss the

spleen, the hand will be placed on

the upper

left quadrant, and the

areas of dullness and

tympany will be delimited. It is important to note that the

spleen will be found in the

The areas between the sixth and tenth

ribs on the left side should not

extend beyond the midline of the

anterior axillary line. To percuss the

kidneys, fist

percussion will be used. One hand will be placed on the

lower back at the

costovertebral angle. To do

this, the hand will be placed there and

percussed, tapping lightly with the

other arm.

It is normal not to feel any

pain. If any

symptom such as pain is present, it will be considered

pathological. Palpation is the last

part of the physical examination. It is

important to emphasize that if the patient

presents any type of abdominal pain,

that area is left for palpation until

the end. Often,

patients,

due to nervousness or anxiety, may have a

very rigid abdomen, either due to

nervousness or anxiety, or as a sign of

peritonitis. For this,

the patient is asked to flex their knees

to relieve the tension in the

abdomen. It is important to know that we are going to

perform a

superficial palpation. A deep palpation.

So it's important to know that the

superficial organs are mainly

the superior surface and anterior border of the

liver, the small intestine, parts of the

colon, and the pylorus.

The deep organs are mainly

the pancreas, the aorta, the

kidneys, the flexures of the colon, and the

ovaries in women. Once

we have done the superficial palpation, we

proceed to do the deep palpation.

This can be single-handed or bimanual

depending on the

examiner's skills and the

patient's build. In this case,

since it is a thin patient, the

deep palpation can be done single-handedly, and

here we try to depress the

abdominal wall between 3 and 5 cm to detect

any mass or tumor that has not been

previously detected. This is

done. There are patients where

masses or tumors can be found

on deep palpation, which can

be normal, such as the colon

full of feces, the aorta,

and so on.

Mainly, within the

special palpations, we have the

palpation of the spleen and the liver. Under

normal conditions, the liver is not palpable. To

become palpable, it must be

enlarged three to four

times its normal size. To perform this

palpation, one hand is placed on

the ninth and eleventh ribs, and pressure is applied

as far as

possible towards the midline. With the other

hand, the liver is palpated. In this patient,

under normal conditions, it is not palpable. If it is

palpable, the patient can be asked to

lie on their

right side so that the liver moves

slightly closer to the midline,

allowing for a more

accurate evaluation. For liver palpation, the "claw hand" technique is

used,

where the patient is asked to

inhale deeply. During inspiration, the liver is palpated.

Under normal conditions, it should not be

palpable; it is

only palpable when enlarged.

Similarly, if

enlargement is noted, the

patient can be asked to lie

on their left side to

allow the liver to move slightly closer

to the midline.

Proper evaluation also involves palpating

the aorta. The aorta can only be

palpated in people of a

slender build. It's done with a pinching motion, and

these palpations are noticeable. Under

normal conditions, they should never be

painful, although they may be uncomfortable.

It's important to emphasize that although they

can be uncomfortable, the patient should not

feel pain. Similarly, when performing the

examination, it's important to pay

attention to the patient's facial expressions

because they can indicate

pain or discomfort that the patient

isn't clearly communicating.