Haem Exam

 
 
 

The Patient

The Hands

The Arms

The Face

The Neck

The Chest

The Abdomen

The Pelvis

The Back

The Legs

 
 
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Tenderness

 
 
Focal Abdominal Tenderness
  • 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
Generalised Abdominal Tenderness
    • Feel For
    • Generalised tenderness over more than one abdominal segment.
    • Significance
    • A feature of peritonism, suggestive of peritonitis.
    • Causes of Peritonitis
    • 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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