OSM
12-02-2006, 09:01 PM
السلام عليكم شباب
هذي بس للي يبي يستفيد كتبت كم ملاحظه مع الدكتور لحالة
SPLEENOMEGALY
بسم الله
===============================================
1ST OF ALL INSPECTION :
( see if the patient is connected to any cannula or laying discomfert and the general apperance of the pateint )
- shape of abdomen ( symmetry & destention )
- coloration of abdomen ( like in jaundice )
- Stria: 2 colores (silver as in obese) & (purple as in cushin's).
- Excuration mark = scratch in obstructive jaundice.
- Type of breath: thoraco abd. Or abd. Thoraco
- obvious intestine movement
- Any obvious pulsation (like in thin ppl)
- scars ( trauma , surgical scar , stria , cautery , ) \ type of scar healing ( primary intention healing or secondary ) if it was secondary , that means it has been inflamed .
- hair distrebution .
- apparent veins .... 2 typs :
1- normal : it is straight , thin , blue .... appears only in thin people or white people or people who reduced there weight so fast .
2- collateral : appears on the sides of the abdomen ( in the falnks ) or around the umbilicus in tortuous look an larg in diameter ( because of inferior vena cava obstruction ) .
- herniation
- movemint with respiration .
- umbilicus :
1- shape ( normally flat or concave ) if protruded = hernia or ascites
2- discharge :
a- pediatric age : ( in wrinki's syndrom )
b- adults : inflammated aria with pus and a baaaaad oddor ( smell ) the main chrectaristical point that you will find the umbilicus is abnormally deep and contains hair ( mainly in males )
c- fistula : advansed stage of abdominal cancer near to the umbilicus ( colon cancer )
e- stones : from a gall blader fistuls with the abdominal wall in chronic cholithiasis patients ( gal stones comes ot of the umbilicus ) .
3- hard nodule : verry late stage cancer which affected the peritoneum.
- abdominal visible masses :
1- site according the abdominal layers :
a- intraabdomin ( we ask the patient to crunch the abdomen , it wil diaappear )
b- muscular layer ( we ask the patient to crunch , it will remain in the same place with no change )
c- subcutaneous layer ( we ask the patien tto crunch , it will protrude more to out side )
2- site according to the whole abdomen
3- size
4- shape
5- skin covring it
6- movement with respiration.
=======
after the inspection whe must check for the hands and whe see in it :
1- color if its pale or yellow
2- temp ( hot or cold extremities)
3- swetty hand
4- muscle wasting
5- clubbing
6- pulse
7- muscle strength
8- nails
9- blood filling
10 - any orthopedic or rhumathologic problems .
then check the respiratory rate and body temp.
in the face tow things are important :
1- the eye : lift the upper conjectiva to see if there is jaundes , and the lowr one the see the color of the congectiva ( pale or not )
2- mouth : see if there is cyanosis or dehydration and the hygene of the mouth .
in the neck you have to check the lymph nods and the thyroid gland .
========================================================
2nd palpatation :
superficial palpatation :
( you must warm up your hands first & expose from mid thigh to the nipple )
- look for tenderness on superficial palpation and start away .
- you must check up for :
a- muscle status ( contracted or relaxed )
it is normal to be relaxed , but some tume its like a deffinsive mechanism ( shy patient )
if it is contracted = rigged abdomen = parital peritonium problem ( e.g. peritonitis )
b- to situate any unvisible masses ( vage and soft examination )
deep palpatation :
( you must ask the patient if there is any pain in the abdomen and then start away from it & while you are examining look straight at the patient's eye to see of there is any tendernes , then examin the whole abdomen ,,, consider that when Pt. in = Ur hand in (meaning when the pt. take a deep inspiration you put your hand in to palpate, in expiration u decreasr the pressure untill he breathes again) )
- we do the deep palpatation to describe the mass and liver and spleen
a- mass : we describe the shpe , size , tendernes , consistency , surface edge , skin attachment and respiratory movement .
b- liver : we start palpatation from the right iliac fossa up ward on the med clavicular line and ask the patient to take deep breaths while palpating
c- 1-we start palpating from the right iliac fossa going medialy upward to the splen and as; the patient to take deep breaths until wee reach the costal margin
2- and then we try to insinuate our fingers betwen the spleen and the costal margin , if it goes in , it is not a spleenic problem
3- we palpate to toche the spleenic notch ( not allways presint )
4- we do the bimanual palpation "Ballutman's"( using both hands one is under the costal margin and the other is on the renal triangle on the back )
if we palpate a mass in both hands that means it is a renal mass
if we palpate the mas on the anterior one , it is a spleenic mass
- You must know how to differentiate between the spleen and the kidney,( for ex. The kidney moves up and down with inspiration but the spleen moves down laterally to the iliac fossa)
==========
3rd percussion
we percuss above the mass that we are intrested in first
and check up for the dull sound and resonance sound
and then percuss on the liver to detrmine the size of it ( normal b\w 8- 12 cm) we percuss on the mid vlavicular line
if the liver is in normal size bute not in the normal location ( we can feel it below the costal margin , that means ther is tearing in the falciform ligamint )
percss on the spleen along its axes till you reach the ribs and then percuss on the 10th rib from the front backward ( because it covers the axes of the spleen ) .
percuss for the ascetic do waves thrill and shifting dullness.
================
4th
oscultation
we hear the bowl sounds in 2 regions
1- under the umbelicus 2 inches
2- in the left illiac fossa
and to hear if there is any bruit ( abdominal aorta anurism ) .
- lestin for a vnous hum.
============
further investigation done as :
rebound tendernes in appendecitis
murphy's sign in cholicystitis
water shffling in ascites
=============
remember :
there is no concer metastize in spleen , that means any cncer in spleen is allways primary
- in any stomach cancer , in surgery we remove part of the stomich and the whole spleen becuse they shar the same lymph node ( hilex lymph noods )
- the shape of the edge of the liver is allways sharp ,,,, and the kidny is rounded but the spleen is in betwen
-YOU SHOULD ALWAYS SAY AT THE END OF ABDOMINAL EXAMINATION: P-R EXAMINATION WAS NOT DONE & HERNIAL ORIFACE & GENETALIA EXAMINATION WAS NOT DONE
==============================================
هذا اللي قدرت عليه يا شباب ان شاء الله تستفيدون منه
ومعليه اعذرونا على نقص المعلومات والسبيلينج وان شاء الله تتوفقون كلكم
ادعوا لي
سلامز
هذي بس للي يبي يستفيد كتبت كم ملاحظه مع الدكتور لحالة
SPLEENOMEGALY
بسم الله
===============================================
1ST OF ALL INSPECTION :
( see if the patient is connected to any cannula or laying discomfert and the general apperance of the pateint )
- shape of abdomen ( symmetry & destention )
- coloration of abdomen ( like in jaundice )
- Stria: 2 colores (silver as in obese) & (purple as in cushin's).
- Excuration mark = scratch in obstructive jaundice.
- Type of breath: thoraco abd. Or abd. Thoraco
- obvious intestine movement
- Any obvious pulsation (like in thin ppl)
- scars ( trauma , surgical scar , stria , cautery , ) \ type of scar healing ( primary intention healing or secondary ) if it was secondary , that means it has been inflamed .
- hair distrebution .
- apparent veins .... 2 typs :
1- normal : it is straight , thin , blue .... appears only in thin people or white people or people who reduced there weight so fast .
2- collateral : appears on the sides of the abdomen ( in the falnks ) or around the umbilicus in tortuous look an larg in diameter ( because of inferior vena cava obstruction ) .
- herniation
- movemint with respiration .
- umbilicus :
1- shape ( normally flat or concave ) if protruded = hernia or ascites
2- discharge :
a- pediatric age : ( in wrinki's syndrom )
b- adults : inflammated aria with pus and a baaaaad oddor ( smell ) the main chrectaristical point that you will find the umbilicus is abnormally deep and contains hair ( mainly in males )
c- fistula : advansed stage of abdominal cancer near to the umbilicus ( colon cancer )
e- stones : from a gall blader fistuls with the abdominal wall in chronic cholithiasis patients ( gal stones comes ot of the umbilicus ) .
3- hard nodule : verry late stage cancer which affected the peritoneum.
- abdominal visible masses :
1- site according the abdominal layers :
a- intraabdomin ( we ask the patient to crunch the abdomen , it wil diaappear )
b- muscular layer ( we ask the patient to crunch , it will remain in the same place with no change )
c- subcutaneous layer ( we ask the patien tto crunch , it will protrude more to out side )
2- site according to the whole abdomen
3- size
4- shape
5- skin covring it
6- movement with respiration.
=======
after the inspection whe must check for the hands and whe see in it :
1- color if its pale or yellow
2- temp ( hot or cold extremities)
3- swetty hand
4- muscle wasting
5- clubbing
6- pulse
7- muscle strength
8- nails
9- blood filling
10 - any orthopedic or rhumathologic problems .
then check the respiratory rate and body temp.
in the face tow things are important :
1- the eye : lift the upper conjectiva to see if there is jaundes , and the lowr one the see the color of the congectiva ( pale or not )
2- mouth : see if there is cyanosis or dehydration and the hygene of the mouth .
in the neck you have to check the lymph nods and the thyroid gland .
========================================================
2nd palpatation :
superficial palpatation :
( you must warm up your hands first & expose from mid thigh to the nipple )
- look for tenderness on superficial palpation and start away .
- you must check up for :
a- muscle status ( contracted or relaxed )
it is normal to be relaxed , but some tume its like a deffinsive mechanism ( shy patient )
if it is contracted = rigged abdomen = parital peritonium problem ( e.g. peritonitis )
b- to situate any unvisible masses ( vage and soft examination )
deep palpatation :
( you must ask the patient if there is any pain in the abdomen and then start away from it & while you are examining look straight at the patient's eye to see of there is any tendernes , then examin the whole abdomen ,,, consider that when Pt. in = Ur hand in (meaning when the pt. take a deep inspiration you put your hand in to palpate, in expiration u decreasr the pressure untill he breathes again) )
- we do the deep palpatation to describe the mass and liver and spleen
a- mass : we describe the shpe , size , tendernes , consistency , surface edge , skin attachment and respiratory movement .
b- liver : we start palpatation from the right iliac fossa up ward on the med clavicular line and ask the patient to take deep breaths while palpating
c- 1-we start palpating from the right iliac fossa going medialy upward to the splen and as; the patient to take deep breaths until wee reach the costal margin
2- and then we try to insinuate our fingers betwen the spleen and the costal margin , if it goes in , it is not a spleenic problem
3- we palpate to toche the spleenic notch ( not allways presint )
4- we do the bimanual palpation "Ballutman's"( using both hands one is under the costal margin and the other is on the renal triangle on the back )
if we palpate a mass in both hands that means it is a renal mass
if we palpate the mas on the anterior one , it is a spleenic mass
- You must know how to differentiate between the spleen and the kidney,( for ex. The kidney moves up and down with inspiration but the spleen moves down laterally to the iliac fossa)
==========
3rd percussion
we percuss above the mass that we are intrested in first
and check up for the dull sound and resonance sound
and then percuss on the liver to detrmine the size of it ( normal b\w 8- 12 cm) we percuss on the mid vlavicular line
if the liver is in normal size bute not in the normal location ( we can feel it below the costal margin , that means ther is tearing in the falciform ligamint )
percss on the spleen along its axes till you reach the ribs and then percuss on the 10th rib from the front backward ( because it covers the axes of the spleen ) .
percuss for the ascetic do waves thrill and shifting dullness.
================
4th
oscultation
we hear the bowl sounds in 2 regions
1- under the umbelicus 2 inches
2- in the left illiac fossa
and to hear if there is any bruit ( abdominal aorta anurism ) .
- lestin for a vnous hum.
============
further investigation done as :
rebound tendernes in appendecitis
murphy's sign in cholicystitis
water shffling in ascites
=============
remember :
there is no concer metastize in spleen , that means any cncer in spleen is allways primary
- in any stomach cancer , in surgery we remove part of the stomich and the whole spleen becuse they shar the same lymph node ( hilex lymph noods )
- the shape of the edge of the liver is allways sharp ,,,, and the kidny is rounded but the spleen is in betwen
-YOU SHOULD ALWAYS SAY AT THE END OF ABDOMINAL EXAMINATION: P-R EXAMINATION WAS NOT DONE & HERNIAL ORIFACE & GENETALIA EXAMINATION WAS NOT DONE
==============================================
هذا اللي قدرت عليه يا شباب ان شاء الله تستفيدون منه
ومعليه اعذرونا على نقص المعلومات والسبيلينج وان شاء الله تتوفقون كلكم
ادعوا لي
سلامز