CLINICAL DIAGNOSIS B PHYSICAL DIAGNOSIS LECTURE – ABDOMEN (AUSCULTATION)

Far Eastern University – Nicanor Reyes Medical Foundation o Lactose Intolerance

CD PD LEC: ABDOMEN - AUSCULTATION o Lactase Deficiency
Dr. Tan, MD - MEDICATIONS
o Laxatives
ABDOMINAL AUSCULTATION ▪ Lactulose
- Performed prior to percussion and palpation ▪ Caster oil
- Assess bowel motility and abdominal complaints ▪ Bisacodyl
▪ Senna
OBJECTIVE: ▪ Xenecot (Dulcolax)
- To Correlate Auscultatory Findings With Abdominal o Prokinetics
Conditions ▪ Motilium
▪ Cisapride
MECHANICAL MOVEMENT  SIEVING  PROPULSIVE  ▪ Domperidone
AIR+FLUID+ INTESTINAL CONTENTS (food particles)  BOWEL ▪ Mosapride
SOUNDS ▪ Loperidon
o Antibiotics
BOWEL SOUNDS ▪ Macrolides
- Hyperactive ▪ Erythromycin
- Normoactive ▪ Clarithromycin
- Hypoactive ▪ Clavulinic Acid
- IRRITABLE BOWEL SYNDROME
HYPERACTIVE BOWEL SOUNDS CLINICAL CONDITIONS o If diarrhea is predominant
DIARRHEA
- Irritable bowel syndrome INTESTINAL OBSTRUCTION, EARLY PHASE
- Loss of electrolytes: Potassium Loss - Common GI problem
- Small Bowel Obstruction(SBO(
INFECTIOUS - Large Bowel Obstruction
- ETEC - Early phase: normal response – Extreme propulsion
- Staphylococcal food poisoning - EXTRINSIC
- Cholera (cholera vibrio)  rice watery stool o Post-Operative Adhesion
- Dysentery ▪ Most common
- Salmonellosis ▪ Manifest as early of one week by may also take
- Shigellosis years
- AMOEBIASIS o Pancreatic Mass
o Common in the Philippines ▪ Tumor
o Amoebic Liver Abscess ▪ Pseudocyst
- SEPSIS ▪ Abscess  acute pancreatitis
o Diarrhea  Constipation ▪ Can compress the duodenum  gastric outlet
o Risk: Extreme of Age (young and old) obstruction
o Immunocompromised o Superior Mesenteric Syndrome
▪ Pneumonia: common and notorious ▪ Visible in sthenic/thin individual
OTHERS ▪ Collapse of superior mesenteric artery
ENDOCRINE • “Pseudoobstruction” (OGILVIE’S SIGN)
- Hyperthyroidism (Grave’s disease) ▪ Can compress small intestine
- Thyroiditis o Ovarian Mass ( Cystic Or Solid)
- Increase Metabolic rate: tachycardia, heat intolerance, and ▪ Teratomas
polyphagia ▪ Ovarian Carcinoma
- Thyroid Function Test: TSH/FT3/FT4 o Uterine Mass
▪ Uterine Myomas
GASTROINTESTINAL PROBLEMS ▪ Carcinomas
- MALABSORPTION - INTRINSIC
o Parasitic o Polyps
o Capillariasis ▪ Familial Polyposis: APC gene mutation (with
▪ Attach to intestinal mucosa  diarrhea genetic predisposition)

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 CLINICAL DIAGNOSIS B PHYSICAL DIAGNOSIS LECTURE – ABDOMEN (AUSCULTATION)
▪ Histology: Adenomatous or Villous (develop ▪ Hyoscine
malignancy) • Buscopan, Dicylcopedine, Bentil
▪ Associated with the food (diet) but still o Pain Relievers/ Narcotics
undocumented ▪ Opioids: Liperidine
o Mass
▪ Carcinomas INTESTINAL OBSTRUCTION, LATE PHASE
▪ Infectious ( Ileocecal Tuberculosis) - Correlate with presence of distention and pain
o Autoimmune - Intussusception
▪ Inflammatory Bowel Disease: affecting mucosa o Telescoping intestine, most commonly small bowel
and muscularis - Volvulus
▪ Crohn’s disease (fibrosis): produce strictures o sigmoid area- common site
leading to obstruction
o Foreign Bodies PERITONITIS
o Parasites - Spontaneous Due To Presence Of Ascites
▪ Ascaris: always in partners, (romantic parasite) o Liver Cirrhosis
▪ Tapeworms: Taenia solium/saginata, up to 10m o Chronic Renal
from duodenum to biliary tracts o Malignancy
o Feces - Malignancy
▪ Fecal Impaction o Meig’s Syndrome Triad
▪ Common in elderly ▪ Ascites, Pleural Effusion, Benign Ovarian Tumor
o Hirschprung’s Disease (Megacolon) - Disease
▪ Particularly rectosigmoid region o Diabetic
▪ Absent nerve innervations o Hypertensive Nephropathy
- Ruptured Viscus
HYPOACTIVE TO ABSENT BOWEL SOUNDS CLINICAL CONDITIONS o Perforated Ulcers
ELECTROLYTE ABNORMALITY o Gangrenous Appendix
- Hypokalemia o Diverticulosis: Meckel’s (Most Common)
o after effect of severe diarrhea - Pelvic Inflammatory Disease
o renal tubular acidosis  potassium loss o STD’s
o familial periodic paralysis ▪ Gonococcal
▪ Chlamydia
ENDOCRINE ▪ Syphilis
- Hypothyroidism
o Myxedema SEPSIS
o Constipation, hypokinesia
o Slow metabolism OGILVIE’S SYNDROME
- pseudo-obstruction
ILEUS - idiopathic signs of blockage without physical blockage
- Prolonged Immobility due to Spinal Cord Injury - Signs and Symptoms: Nausea and Vomiting
- Spinal Cord Injury
o Trauma OTHER SOUNDS
o Degenerative Disease BORBORYGMI
▪ Kyphosis - audible intestinal rumbling associated with early obstruction,
▪ Scoliosis hunger fangs
▪ Anjylosing Spondylitis
- Neurologic BRUIT/MURMURS
o Demyelinating disease - Presence indicates turbulent blood flow
▪ Multiple Sclerosis o Abdominal Aortic aneurysm
▪ Amyotrophic Lateral Sclerosis ▪ Prolonged uncontrolled hypertension
- Medications ▪ Atherosclerosis
o Anti Spasmolytic o Renal artery stenosis
▪ Before giving this kind of medication, be sure o Hepatoma
that the patient has no intestinal obstruction to ▪ increase blood flow due to neovascularization
prevent iatrogenic injury like perforation o Abscess

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 CLINICAL DIAGNOSIS B PHYSICAL DIAGNOSIS LECTURE – ABDOMEN (AUSCULTATION)
SUCCUSSION SPLASH
- Produce due to the combination of air and fluid
- Drinking large volume on emptying stomach
- Normal gastric emptying time (disappears) in 2-4 hours
- A very loud splash + distention suggests obstruction in
stomach with gastric dilatation

Gastric Outlet Obstruction

- Pyloric Stenosis
o Congenital
o Tumors
o Iatrogenic: Caustic Substance
- Mass
o Polyp
▪ Familial Polyposis
o Leiomyomas
▪ Most Common Benign Tumor
o Gastric Carcinoma (Antral Area)
▪ H. Pylori  Stricture
o Large Kissing Duodenal Ulcers
o Infectious
▪ Tuberculosis Of The Duodenum
o Pancreatic Head Mass

FRICTION RUB
- Sound described as 2 pieces of leather rubbing together
- Splenic Infarct
o Banti’s syndrome
- Liver abscess
- Lung Abscess (most common)
o Amoebic or Bacterial
- Peritonitis

DIAGNOSTICS
- CBC/ electrolytes
- Abdominal X-ray
o Upright Or Supine
- Ultrasound
o Upper or lower or Whole abdomen
- CT scan/ MRI -/+ contrast
- Virtual Colonoscopy
- Barium Enema
- Small Bowel Series
- Endoscopy
o Gastroscopy
o Colonoscopy

FETAL HEART TONES

- palpation prior to auscultation to search for fetal back
- best heard in fetal back parts
o Leopold’s Maneuver

Notes from Lecture PPT and MRA trans

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