Abdominal Examination,Introduction,Question1 : What do you think is the better or more appropriate sequence of abdominal examination compared with that in other areas? And why?,Normal sequence: inspection, palpation, percussion, and auscultation,Abdominal examination: inspection, auscultation, percussion, and palpation Its convenient to perform the auscultation of abdomen after the auscultation of the heart. To avoid the negative impacts of a series of palpations on auscultation of bowel sounds due to the alteration of peristalsis.,Question 2: Can we say that abdominal examination will be outmoded and superseded because of remarkable advances in supplementary examination methods such as X-ray, ultrasound, endoscopy, isotope, angiography, CT, MRI, etc. ?,Definitely Not.,Because the abdominal examination is a fundamental method of detecting abnormal signs of abdomen. Palpation is the most difficult step of abdominal examination, requiring more practice.,Anatomic Landmarks, xiphoid (ensiform) process(剑状突起) of sternum(胸骨) costal margin肋弓缘 umbilicus脐 anterior superior iliac spine髂前上棘 inguinal ligament 腹股沟韧带 superior margin of os pubis耻骨上缘 anterior midline/midabdominal line前中线/腹中线 lateral border of rectus muscles 腹直肌外缘 symphysis pubis (耻骨联合),腹股沟韧带 inguinal ligament,costal margin,耻骨上缘 superior margin of os pubis,Anterior superior iliac spine,xiphoid process,Lateral border of rectus muscle,umbilicus,腹中线midabdominal line,Commonly used methods of subdividing the abdomen,Zones of abdomen 腹 部 分 区,Four quadrants Nine sections,right lower quadrant,right upper quadrant,left upper quadrant,left lower quadrant, The anterior surface of the abdomen is divided into four quadrants by two intersecting lines, one extending vertically from the xiphoid, through the umbilicus, to the symphysis pubis (耻骨联合)and the other extending horizontally across the abdomen at the level of the umbilicus., This divides the abdomen into the RUQ (right upper quadrant), RLQ (right lower quadrant), LUQ (left upper quadrant), and LLQ (left lower quadrant. The content of the abdomen underlying each of the four quadrants should be known as follows:,Right upper quadrant Liver Gallbladder胆囊 Duodenum十二指肠 Caput pancreas胰头 Right kidney右肾 Hepatic flexure of colon结肠肝曲,Left upper quadrant Stomach Spleen脾 Left kidney左肾 Cauda pancreas胰尾 Splenic flexure of colon结肠睥曲,Right lower quadrant Cecum盲肠 Appendix阑尾 Right ovary and uterine tube右侧卵巢及输卵管 Right ureter右输尿管,Left lower quadrant Sigmoid colon乙状结肠 Left ovary and uterine tube左侧卵巢及输卵管 Left ureter左输尿管,epigastric region,umbilical region,hypogastric region,right hypochondrial,left hypochondrial,right lumber region,right iliac region,left lumber region,left iliac region,Two imaginary, parallel, horizontal lines across the lowest border of the costal margin across the anterior superior iliac spine,Two imaginary, parallel, vertical lines across the middle of linking line formed by left anterior superior iliac and midabdominal line across the middle of linking line formed by right anterior superior iliac and midabdominal line,Left hypochondrial region左上腹部；左季肋部 Spleen; stomach; splenic flexure of colon; cauda pancreas; left kidney; left adrenal gland(左肾上腺),Left lumber region左侧腹部；左腰部 Descending colon(降结肠); jejunum(空肠) or ileum(回肠); left kidney,Left iliac region左下腹部；左髂部 Sigmoid colon; female left ovary and uterine tube; male left varicosity(精索) and lymph node,Right hypochondrial region右上腹部；右季肋部 Right lobe of liver(肝右叶); gallbladder; hepatic flexure of colon; right kidney; right adrenal gland,Right lumber region右侧腹部；右腰部 Ascending colon; jejunum(空肠); right kidney,Right iliac region右下腹部；右髂部 Cecum(盲肠); appendix; lower part of ileum(回肠); lymph node; female right ovary and uterine tube; male right varicosity,Epigastric region上腹部 Stomach; left lobe of liver; duodenum(十二指肠); caput pancreas and body of pancreas; transverse colon; aorta abdominalis(腹主动脉); omentum majus/the greater omentum (大网膜),Umbilical region中腹部；脐部 Lower part of duodenum; jejunum; ileum; ptosis(下垂) part of the stomach or transverse colon; ureter(输尿管); aorta abdominalis; mesentery(肠系膜) and lymph nodes; omentum majus,Hypogastric region下腹部 Ileum; sigmoid colon; ureter; full bladder; pregnant uterus(子宫),Question 3: What are the distinct benefits and disadvantages in Four-quadrant and Nine-section methods?,Four-quadrant simple, practical, rough, imprecise (tenderness of epigastric regin) Nine-section elaborates more clearly and more exactly inconvenient limited scope of left or right hypochondrial region, left or right iliac region,Inspection,notesposition (supine)scope of exposure (adequate, xiphoid process - symphysis pubis, others covered ) sequence angle (side, tangent),