Inspect the Abdomen

The contour of the abdomen should be assessed. A scaphoid, or concave, abdomen may be associated with cachexia;a protuberant abdomen may result from gaseous distention of the intestines, ascites, (splenomegaly lator), or obesity. When a patient with ascites stands, the fluid sinks into the lower abdomen; when lying supine, the fluid bulges in the flanks. If a patient with ascites lies on the side, the fluid flows to the dependent lower side. A patient with a protuberant abdomen as a result of carcinomatous ascites is shown in Figure 17-10.

The examiner should focus attention on the abdomen to describe adequately the presence of any asymmetry, distention, masses, or visible peristaltic waves. The examiner should then observe the abdomen from above, looking for the same signs. Inspection of the abdomen for striae and scars may provide valuable data. Silver striae are stretch marks consistent with weight loss. Pinkish-purple striae are classic signs of adrenocortical excess. Figure 17-11 shows the characteristic purplish striae in a patient with Cushing's syndrome.

Is the umbilicus everted? An everted umbilicus is often a sign of increased abdominal pressure, usually from ascites or a large mass. An umbilical hernia may also cause an umbilicus to become everted.

Are there ecchymoses on the abdomen or on the flanks? Massive ecchymoses may occur in these areas as a result of hemorrhagic pancreatitis or strangulated bowel. This is Grey Turner's sign.

Cullen's sign is a bluish discoloration of the umbilicus resulting from hemoperitoneum of any cause.

Recognition of classic surgical scars may be helpful. Figure 17-12 shows the locations of some common surgical scars.

Inspection Umbilical HerniaEffect Abdomen Ascites Scar

Figure 17-12 Locations of common surgical scars. Inspect for Hernias

The patient lying in bed should be asked to cough while the examiner inspects the inguinal, umbilical, and femoral areas. This maneuver, by increasing intra-abdominal pressure, may produce a sudden bulging in these areas, which may be related to a hernia. If the patient has had surgery, coughing may reveal a bulging along the abdominal scar from the previous incision. In addition, coughing may elicit pain localized to a specific area. This technique enables the examiner to identify the area of maximal tenderness and to perform most of the abdominal examination without too much discomfort to the patient. Ascites secondary to metastatic breast carcinoma and an umbilical hernia are shown in Figure 17-13.

Figure 17-12 Locations of common surgical scars. Inspect for Hernias

The patient lying in bed should be asked to cough while the examiner inspects the inguinal, umbilical, and femoral areas. This maneuver, by increasing intra-abdominal pressure, may produce a sudden bulging in these areas, which may be related to a hernia. If the patient has had surgery, coughing may reveal a bulging along the abdominal scar from the previous incision. In addition, coughing may elicit pain localized to a specific area. This technique enables the examiner to identify the area of maximal tenderness and to perform most of the abdominal examination without too much discomfort to the patient. Ascites secondary to metastatic breast carcinoma and an umbilical hernia are shown in Figure 17-13.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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