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Gastro Exam
 
 

Abdominal Movement

 
 
 
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Paradoxical Respiration

Normally, the abdomen moves outward on inspiration and inward on expiration.
Paradoxical movement of the abdomen - inward on inspiration and outward on expiration - is suggestive of diaphragmatic paralysis or fatigue.
  • Causes of Paradoxical Respiration

  • Diaphragmatic paralysis - unilateral or bilateral
  • Fatigue - respiratory failure, neuromuscular disease

Abdominal Pulsation

  • Look For

  • An obvious pulsation within the abdomen.
  • Significance

  • Suggestive of abdominal aortic aneurysm, though the normal pulsation of the abdominal aorta may be visible in thin people.

Visible Peristalsis

  • Look For

  • Waves of movement across the abdomen, often starting in the left upper quadrant and moving toward the right lower quadrant.
  • Significance

  • Mechanical intestinal obstruction.
  • Causes of Visible Peristalsis

  • Hernia
  • Diverticular disease
  • Tumour - colorectal, lymphoma
  • Adhesions - congenital, surgery, inflammation
  • Strictures - Crohn’s, surgery, radiotherapy
  • Foreign body - swallowed material, bezoar, parasite
  • Intussusception
  • Volvulus
Non-mechanical causes of obstruction such as paralytic ileus and Ogilvie's syndrome will not result in visible peristalsis as gut motility is reduced.
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