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

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4. Palpation of massesthe masses of abdomen
may be caused by enlarged organ
ectopic organ cyst carcinoma
inflammatory tissues enlarged lymphnode
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(1)Normal masses of abdomen tendon of abdominal
rectus lumber vertebral body sacral
promontory sigmoid colon transverse colon
cecum
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(2).Abnormal mass of abdomen when you palpate
the mass of abdomen you should describe the
location size contour
consistency tenderness
pulsation mobility
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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.
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big mass without intestinal obstruction, the mass
originate from mesentery peritoneum
omentum postperitoneum
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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, babys head and so on.
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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.
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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
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? 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
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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
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The pulsation of mass abdominal aneurysm or a
mass next to the aorta enlargement of
liver with pulsation tricuspid valve
incompetence
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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
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? 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
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5. Fluid wave thrill with the patient in supine
position, the examiners 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
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The examinerss 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 examiners
left hand as a sharp impulse.
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6. Succussion splash
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Succussion splashthis examining method can check
for retention of gastric fluid. If succussion
splash is positive after meal 6-8 hours
indicating pyloric obstruction
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Percussion
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Percussion can check for the presence of
abdominaldistention, tumor, fluid, enlargement
of viscera.percussion tone of abdomen liver
spleen dullness flatness remains tympany.
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Percussion of liver
--upper margin
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Percussion of liver --lower
margin
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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
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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
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Percussion of spleennormal left midaxillary
line 9th 11th intercostal space width
4-7cm enlargement of splenic dullness
splenomegaly
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traube area tympanitic area of stomach
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Percussion of ascites shifting dullness gt1000ml
elbow-knee position check for small amount
ascites
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Auscultation
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bowel soundnormal 4-5times /min increased
gt10times acute intestinitis, loud high-pitched
tinkling quality intestinal obstruction
decreased or disappeared acute
peritonitis, intestinal paralysis,
electrolyte disorder
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vascular bruitsystolic bruit partial occlusion
of renal artery above umbilicus left or
right side hepatic cancer lesion
areaabdominal aneurysm or partial occlusion
of abdominal aorta
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Vein bruit periumbilicus, upper abdomen or over
the liver continuous humming sound, seen in
portal hypertension caused by cirrhosis of liver
Friction rubover the spleen or over the liver
perisplenitis caused by spleen infarction
perihepatitis