腹部分区－九区法 右上腹部（右季肋部 right hypodriac region ） 上腹部（ epigastric region ） 左上腹部（左季肋部 Left hypodriac region ） 右侧腹部（右腰部 right lumber region ） 中腹部（脐部 umbilical reglon ） 左侧腹部（左腰部 left lumber reglon ） 右下腹部（右髂部 right iliac region ） 下腹部（耻骨上部 hypogastric region ） 左下腹部（左髂部 left iliac region ）
Purpose of clinical examination To find evidence in support of or against the differential diagnosis you are considering after taking the history. It should be thorough enough so as not to miss other possibilities that you had not considered. To consider causes and effects of each putative diagnosis.
Palpation Superficial palpation is to detect tenderness, rebound tenderness, guarding or rigidity. Deep palpation is to detect organomegaly and masses. Do not hurt the patients!! If the patient with pain, examine the hernial orifices carefully for a strangulated hernia.
Auscultation Bowel sound (volume, pitch, frequency) Bruits Accentuated ausculation (listening with stethoscope over solid structure while lightly scratching over organ edge) can also be used to confirm liver or spleen enlargement.
Rectal Examination Preparation: Make the patient understands what you want to do and why (consent) Have a assistant present ( same sex as patient) Position patient in left lateral fetal position Use xylocaine or jelly on gloved hand
Rotate finger to feel for Mass lesions (e.g. cancer, polyps) Edema, induration (inflammatory bowel disease) Abnormalities of the stool (constipation, dirrhoea) Palpate prostate anteriorly in men and the cervix in women
Seen on the glove: Fresh blood and pus in patients with cancer or mucosal inflammation Melaena in patients with upper GI bleeding Patients with abdominal pain: Localized tenderness to the palpating finger may help in diagnosing: Appendicitis Pelvic inflammatory disease
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