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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
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.