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Excellence in the Physical Exam Series | The Abdomen

Mike Weinstock, MD and Bob Culley, DO
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The abdominal exam is an important aspect to medicine that we all need to utilize. Mike and Bob discuss the important aspects of Inspection, percussion and palpation of the abdomen is the most important aspect in the acute care setting.  Breaking down the exam into four quadrants with different disease processes often associated with each quadrant is a practical approach.

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Ian L., Dr -

It is not wrong to listen for a murmur which can be heard in chronic atherosclerotic ischaemic where the mesenteric arteries are stenosed the uncommon abdominal angina.
Other causes of a abdominal murmur are hereditary hemorrhagic telangiectasia involving say the liver pseudo aneurysm of the iliac arteries .
The paper by BergerJS et al in J VascSurg Sept ; 58(3)673-81 Modifiable Risk Factor burden and prevalence of peripheral artery disease in different vascular territories which included 3,319,993 participants in the Life Line Screening programme reveals interesting correlates .

Mike W., MD -

Interesting thoughts. Yes, a murmur from stenosis is a consideration. Of course, most use the stethoscope on the abdomen to listen for bowel sounds, which in the uncomplicated abdominal pain patient has an incredibly low yield. But an interesting consideration for a murmur...

David S. -

This is a bit of an old episode now and I can’t see past the firewall for the article regarding bowel auscultation, but I am curious if there was any utility in having no bowel sounds, a lower frequency of bowel sounds, or if they only played the bowel sounds that were made in the patients with a SBO or ileus? Thanks!

Mike W., MD -

HI David, thx for the comment! I am not aware of any utility to listening for bowel sounds in the typical patient with abdominal pain based either on the literature or on my clinical experience. If SBO is suspected based on hx and exam, it is hard to imaging a finding of bowel sounds which would either result in me sending a noncercning pt to the ED or decreasing my concern to the point of UC discharge in a concerning patient.
Thx David!!

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Ice, Ice Baby Full episode audio for MD edition 185:05 min - 87 MB - M4AHippo Urgent Care RAP - November 2017 Written Summary 488 KB - PDF