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Deteriorating Patient

Abdominal Palpation


Abdominal Tenderness

  • Ask the patient to indicate where on the abdomen is painful. Superficially palpate the nine segments of the abdomen to elicit tenderness. If none is present, palpate more deeply.
    • Interpretation

    • Right hypochondrium - liver, gallbladder, stomach, hepatic flexure of colon, lungGallstones, peptic ulcer
    • Epigastrium - liver, gallbladder, stomach, transverse colon, pancreas, heartPancreatitis, peptic ulcer, reflux
    • Left hypochondrium - spleen, pancreas, stomach, splenic flexure of colon, lungPeptic ulcer, pancreatitis
    • Right lumbar - ascending colon, kidneyKidney stone, pyelonephritis
    • Umbilicus - small bowel, aortaPancreatitis, early appendicitis, peptic ulcer, IBD
    • Left lumbar - descending colon, kidneyKidney stone, diverticulitis, IBD
    • Right iliac fossa - appendix, terminal ileum, caecum, ovary, fallopian tube, ureterAppendicitis, caecal diverticulitis, ovarian pathology, ectopic pregnancy, PID, inguinal hernia
    • Hypogastrium - uterus, bladder, sigmoid colonCystitis, appendicitis, diverticulitis, IBD, uterine pathology
    • Left iliac fossa - sigmoid colon, ovary, fallopian tube, ureterSigmoid diverticulitis, ovarian pathology, ectopic pregnancy, PID, inguinal hernia

Signs of Peritonism

  • Peritonism refers to inflammation of the peritoneum, which suggests acute abdominal pathology that should be rapidly diagnosed and treated.
    • Signs of Peritonism

    • Generalised abdominal tenderness
    • Percussion tenderness - gently percuss the abdominal wall over an area of tenderness. Note whether percussion tenderness is localised or generalised.
    • Rebound tenderness - apply pressure to the patient's abdomen over a tender area for 5-10 seconds. Remove the pressure suddenly, and ask the patient if it hurts more when you press or remove your hand.
    • Causes of Peritonism

    • Infection post perforation - appendix, diverticulitis, IBD, perforated ulcer, surgical anastomosis
    • Spontaneous bacterial peritonitis (SBP)
    • Blood - endometriosis, ruptured ovarian cyst, trauma
    • Bile - post-surgical
    • Urine - pelvic trauma
    • Pancreatic fluid - pancreatitis
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