OS 206: PE OF THE ABDOMEN | SPCABELLERA, UPCM Class 2021

INTRODUCTION
Good morning/afternoon, Dr. ____. I am ___, an LU3 student of UPCM and I am here for the Abdominal PE. May I proceed? Magandang umaga/hapon po! Ako po si ___, isang mag-aaral ng UP
Kolehiyo ng Medisina. Andito po ako para suriin ang inyong tiyan.
Andito po si Dr. ___ para gabayin ang ating eksaminasyon. Gusto ko
lang ipaalam na lahat ng gagawin natin ay sa atin lang po.
Kung maari lang po ay tanggalin niyo po ang pantaas na damit at
humiga po kayo ng nakatihaya.
INSPECTION
I will now begin inspection of the patient. May bahagi po ba sa tiyan niyo na masakit ngayon? Maari niyo pong
. Note: ituro sa akin?
Contour
- Flat, rounded, protuberant, scaphoid (markedly concave or hollowed)?
Symmetry
- Asymmetric or symmetric?
Relation to inspiration
- Any sign of respiratory distress?
Presence of abdominal movements/pulsations
- Peristalsis? Aortic pulsations? *Common in thin people
Presence/absence of engorged veins, scars, skin lesions, discolorations, masses
The patients abdomen appears to be (contour) and (symmetry). There are no signs of respiratory distress. There is (presence of
abdominal movements/pulsations) as well as (presence/absence of engorged veins, skin lesions, masses).
ASUCULTATION
I will now begin auscultating the patients abdomen. Papakinggan ko na po ang inyong tiyan. Sabihin niyo po sa akin kung
Auscultate each quadrant thoroughly. may masakit.
Note:
Bowel sounds
- Clicks/gurgles with frequency of 5-34/minute is normal
- Borborygmi (prolonged gurgles of hyperperistalsis; stomach growling)
Bruits
- Vascular sounds resembling heart murmurs; may indicate vascular occlusive disease
- Auscultate: R and L renal arteries, aorta, R and L iliac arteries

Friction rubs
- Auscultate: liver, spleen
Succusion splash
- Sloshing sound heard with patients sudden movement; suggests presence of gas or fluid in an obstructed organ
- Rock patient back and forth (side to side if supine) while auscultating all quadrants
There is presence of bowel sounds at (frequency). There appears to be (presence/absence of bruits, friction rubs, succusion
splash).
OS 206: PE OF THE ABDOMEN | SPCABELLERA, UPCM Class 2021
PERCUSSION
I will now begin percussing the patients abdomen. Tatapikin ko na po ang inyong tiyan. Sabihin niyo po sa akin kung may
Note: masakit.
Liver span (6-12cm in R MCL, 4-8cm in MSL) (If patient is female, gently displace breast to access thoracic area)
- Percuss below nipple line, MCL (should be resonant lungs), percuss downwards (becomes dull liver) mark
area between resonance and dullness, then percuss downwards (becomes tympany colon), mark area
between dullness and tympany, measure with ruler

Spleen
- Percuss Traubes space (left lower anterior chest from border of cardiac dullness at 6 th rib to AAL, then from
costal margin to AAL)
- Prominent tympany = no splenomegaly
- Splenic percussion sign: percuss lowest interspace in L AAL patient breathes deeply; percuss again change
to dullness indicates splenomegaly, (+) splenic percussion sign

Fluid wave
- Patient places ulnar side of hand on middle abdomen (stops transmission of wave through fat) tap one flank
sharply with fingertips, feel on opposite flank for transmitted fluid impulse repeat on other side
- (+) fluid impulse suggests ascites

Shifting dullness
- Patient turns to one side percuss and mark borders, note changes
OS 206: PE OF THE ABDOMEN | SPCABELLERA, UPCM Class 2021
Costovertebral angle tenderness (CVAT)
- Patient sits up; place fingertips onto lower border of 12th rib and transverse processes of adjacent lumbar
vertebrae on L side tap fist once or twice onto fingertips if pain is elicited, there is (+) CVAT of kidney
repeat on other side

The patients liver span appears to be (measurement in cm). The patients spleen also appears to be (describe size, (+/-) splenic
percussion sign). The patient tested (+/-) on shifting dullness, indicating (presence/absence of ascites). The patient tested (+/-)
on costovertebral angle tenderness, indicating (presence/absence of tenderness of the kidney).
PALPATION
I will now begin palpating the patients abdomen. Hahawakan ko na po ang inyong tiyan. Sabihin niyo po sa akin kung
Note: may masakit.
Tenderness
- Direct and rebound tenderness
Organs
- Liver: Place L hand behind patient, II to and supporting 11 th-12th ribs and adjacent soft structures press L
hand upwards, palpate for inferior edge of liver using R hand below lower border of liver with fingers pointing
superiorly patient breathes deeply palpate for liver, lighten pressure, note tenderness, liver edge [soft,
sharp, regular, smooth surface]

- Liver (hooking technique): Place B hands side to side below inferior border of liver, press in with fingers and up
toward costal margin patient breathes deeply palpate
OS 206: PE OF THE ABDOMEN | SPCABELLERA, UPCM Class 2021
- Spleen: Reach over with L hand around patients lower left rib cage, press hand forward R hand palpates
below L costal margin, AAL patient breathes deeply palpate edge of spleen, note tenderness, contour,
distance from lowest point to left costal margin repeat with patient lying on R side with hips and knees flexed

- Retroperitoneal structures: L Kidney: Place R hand behind patient below and II to 12 th rib at CVA lift, displace
kidney anteriorly place L hand over LUQ patient breathes deeply at inspiration, press L hand firmly and
deeply into LUQ below costal margin patient breathes out, stops breathing briefly slowly release pressure,
note size, contour, tenderness; repeat on other side with switch of hand positions for R kidney

Presence of masses and hernias

Retroperitoneal structures
Murphys sign
- RUQ pain and tenderness suggest acute colecytitis
- Hook L thumb or fingers of R hand under costal margin at point where lateral border of rectus intersects costal
margin ask patient to breathe deeply note breathing and degree of tenderness
Rovsings sign
- Referred rebound tenderness for acute appendicitis
- Press deeply and evenly in LLQ quickly withdraw fingers
Psoas sign
- Suggests acute appendicitis
- Place hand on patients R knee patient flexes hip against resistance
- Alternative: patient lies on left side, passively extend R hip
Obturator sign
- Suggests irritated obturator internus by acute appendicitis
- Flex patients R hip with knee flexed, then rotate hip internally
The patient presents with (presence/absence of tenderness of liver). The liver appears (soft, sharp, regular, and smooth) upon
palpation. The patient also presents with (presence/absence of tenderness of liver). The spleen appears (contour, distance).
There is ((+/-) CVAT over L/R kidney. L/R kidney appears (size, contour). There appears to be (presence/absence of
masses/hernias). Patient tested (+/-) for (___sign), suggesting (presence or presence of condition).
CLOSING
Those are all my findings, Dr. ___. Is there anything else you would like me to do? Tapos na po ang eksaminasyon. Maraming salamat po!
Thank you, Dr. ___.