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PEMERIKSAAN FISIK ABDOMEN

SGD 09
INSPEKSI
9 Regio Abdomen
Kuadran Abdomen
LOCATIONS of ABDOMINAL ORGANS
The schematic below is a reminder of what
organs are likely to produce findings in
each region.
For example:
• Right hypochondriac (RUQ) : liver and gall
bladder
• left hypochondriac (LUQ) : the spleen and
stomach
• epigastric : the pancreas, stomach and
common bile duct
• umbilical : the small intestine
• lumbar : the kidneys
• iliac regions : the ovaries
• left iliac/LLQ : the sigmoid colon
• right iliac or lumbar (RLQ): the cecum and
appendix
• suprapubic : the bladder and uterus
SOME COMMON FINDINGS on ABDOMINAL
INSPECTION
• Scars : Jaringan parut
• Striae (stretch marks) : tanda peregangan ibu hamil
• Colors : - Bluish color at the umbilicus is Cullen's sign – a sign
of bleeding in the peritoneum.
- Bruises on the flanks are Grey Turner's sign
(retroperitoneal bleeding - e.g. from inflamed
pancreas)
• Jaundice : warna kuning pada kulit
• Prominent veins : may be due to portal vein
obstruction or inferior vena cava obstruction
ABDOMINAL DISTENSION
Distension of the lower abdomen only can be
caused by pregnancy, full bladder, ovarian tumor,
or uterine fibroids (common benign growths)
Diffuse abdominal distension can be caused by
any of the 6 Fs:
• Fat (obesity)
• Fluid (ascites - peritoneal fluid - or obstructed viscera
filled with fluid)
• Flatus (air) - e.g. from air swallowing or intestinal
obstruction
• Feces (constipation
• Fetus (pregnancy)
• Fatal cancer.
AUSKULTATION
GUT SOUNDS

• Use the diaphragm of your stethoscope to listen to gut sounds


• Normal gut sounds are gurgling, 5 to 35 per minute
• Borborygmi are loud, easily audible sounds. They are normal, too.
• High pitched , tinkling (raindrops in a barrel) sounds are a sign of
early intestinal obstruction
• Decreased sounds: (none for a minute) are a sign of decreased gut
activity. Gut sounds may be markedly decreased after abdominal
surgery; abdominal infection (peritonitis) or injury.
• Absent Sounds : (no sounds for 5 minutes) are a bad sign. They
can be caused by longer-lasting intestinal obstruction, intestinal
perforation or intestinal (mesenteric) ischemia or infarction
PERKUSI
What it finds: liver size (kind of), spleen, fluid.
Percussing the body gives one of three notes:
• Tympany is found in most of the abdomen,
caused by air in the gut. It has a higher pitch
than the lung.
• Resonance is found in normal lung. It is lower
pitched and hollow.
• Dullness is a flat sound, without echoes. The
liver and spleen, and fluid in the peritoneum
(ascites: ah-SY-teez), give a dull note.
A. Liver Span
• Percuss downward from the chest in the right midclavicular line
until you detect the top edge of liver dullness.
• Percuss upward from the abdomen in the same line until you detect
the bottom edge of liver dullness.
• Measure the liver span between these two points. This measurement
should be 6-12 cm in a normal adult.

B. Splenic Dullness
• Percuss the lowest costal interspace in the left anterior axillary line.
This area is normally tympanitic.
• Ask the patient to take a deep breath and percuss this area again.
Dullness in this area is a sign of splenic enlargement.
Shifting Dullness
This is a test for peritoneal fluid (ascites). ++
• Percuss the patient's abdomen to outline areas of dullness and tympany.
• Have the patient roll away from you.
• Percuss and again outline areas of dullness and tympany. If the dullness has
shifted to areas of prior tympany, the patient may have excess peritoneal
fluid.

Psoas Sign
This is a test for appendicitis. ++
• Place your hand above the patient's right knee.
• Ask the patient to flex the right hip against resistance.
• Increased abdominal pain indicates a positive psoas sign.

Obturator Sign
• This is a test for appendicitis. ++
• Raise the patient's right leg with the knee flexed.
• Rotate the leg internally at the hip.
• Increased abdominal pain indicates a positive obturator sign.
PALPASI
General Palpation
1. Begin with light palpation.
At this point you are mostly
looking for areas of
tenderness. The most
sensitive indicator of
tenderness is the patient's
facial expression (so watch
the patient's face, not your
hands). Voluntary or
involuntary guarding may
also be present.
2. Proceed to deep palpation
after surveying the abdomen
lightly. Try to identify
abdominal masses or areas
of deep tenderness
Palpation of the Liver
Standard Method
• Place your fingers just below the right costal
margin and press firmly.
• Ask the patient to take a deep breath.
• You may feel the edge of the liver press
against your fingers. Or it may slide under your
hand as the patient exhales. A normal liver is
not tender.

Alternate Method
• This method is useful when the patient is
obese or when the examiner is small
compared to the patient.
• Stand by the patient's chest.
• "Hook" your fingers just below the costal
margin and press firmly.
• Ask the patient to take a deep breath.
• You may feel the edge of the liver press
against your fingers.
Penyakit Pada Abdomen
Penyakit yang sesuai dengan regio
Tabel 3. Pembagian Regio Abdomen dan Penyebab Nyerinya
Lokasi Nyeri Abdomen Penyebab Nyeri
Epigastrium Pankreatitis, ulkus duodenum, ulkus gaster,
kolesistitis, kanker pankreas, hepatitis, obstruksi
intestinal, apendisitis (gejala awal), abses
subfrenikus, pneumonia, emboli paru, infark
miokard
Hipokondrium kanan Kolesistitis, kolangitis, hepatitis, pankreatitis, abses
subfrenikus, pneumonia, emboli paru, nyeri miokard
Hipokondrium kiri Nyeri limpa karena limpoma, infeksi virus, abses
subfrenikus, ulkus gaster, pneumonia, emboli paru,
nyeri miokard
Periumbilikalis Pankreatitis, kanker pankreas, obstruksi intestinal,
aneurisma aorta, gejala awal apendisitis.
Lumbal Batu ginjal, pielonefritis, abses perinefrik, Ca kolon.

Inguinal dan suprapubik Penyakit di daerah kolon, apendisitis pada


inguinalis kanan, penyakit divertikulosis sisi kiri,
salpingitis, sistitis, kista ovarium, kehamilan ektopik.

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