Examen físico de Abdomen

Introduction to Abdominal Physical Examination

The video introduces the physical examination of the abdomen, covering four modalities and emphasizing the correct technique for gathering information. It highlights essential points for conducting an examination, with a focus on general physical exams in early medical studies.

Inspection of the Abdomen

• Inspection begins as soon as the patient enters the consultation room, observing for antalgic postures where the trunk deviates towards the painful area.

• During inspection, check for visible lesions, surgical stigmata, typical scars from interventions, variations in body hair distribution, and presence of masses by asking the patient to contract their abdomen.

Auscultation and Percussion

• Auscultation involves listening for hydroaerial sounds that indicate normal intestinal activity; decreased sounds may suggest a paralytic ileus or obstruction.

• Percussion techniques are similar to those used on the chest. Differentiate between dull (e.g., liver) and resonant (e.g., stomach) sounds to locate organs like liver and spleen.

Palpation Techniques

• Palpation is crucial for assessing abdominal pain. Start by determining tender areas before exploring deeper regions using maneuvers like palpating from superior to inferior.

Physical Examination Signs in Abdominal Pathology

In this section, the speaker discusses various physical examination signs that are indicative of abdominal pathologies such as appendicitis and ascites.

Palpation Signs

• The Murcia sign is characterized by a painful interruption of inspiration upon palpating a specific point on the patient's abdomen. This sign is positive if the patient experiences pain during inspiration.

Mac Burney Point and Barbour Point

• Mac Burney point, also known as the point of McBurney, is a classic sign of appendicitis. It is located between the iliac crest and the umbilicus, specifically at the outer third to middle third of this line.

• Barbour point, which does not cause pain upon compression, can help diagnose appendicitis when there is tenderness upon release.

Many Points of Lanz

• Multiple tender points called Many Points of Lanz are parallel to the midline and located above the level of the umbilicus. Compressing these points can help identify issues with structures like ureters.

Signs for Abdominal Conditions

This section delves into additional signs used in diagnosing abdominal conditions such as peritonitis and ascites.

Bloomberg Sign and Abdominal Rigidity

• The Bloomberg sign indicates diffuse inflammation in an acute abdomen scenario. It involves assessing for widespread inflammation due to visceral perforations, leading to a rigid abdomen.

Cullen's Sign and Grey Turner's Sign

• Cullen's sign refers to periumbilical bruising associated with hemorrhagic pancreatitis or ectopic pregnancy.

• Grey Turner's sign involves bruising along the flanks due to retroperitoneal bleeding from conditions like acute pancreatitis or ruptured abdominal aortic aneurysm.