Inspectie

Culoare tegumentara
Mase
Cauze: Hernii Ombilicale, Ventrale, Inghinale

Cicatrici
Chirugical
Traumatic
Striuri
Roz-Mov-cushing
Plagi
Distensie simetrica/asimetrica
Cauze: Obstructii
Tumori
Hepatomegalie
Ascita
Splenomegalie
Constipatie
AAA
Sarcina
Glob Vezical
RetractieOmbilic- Pancreatita
Aspect de Scara – Ocluzie intestine subtiri
Aspect de Potcoava- Ocluzie intestine gors
Ascita
Colaterale Venoase !!!!!!! Apesi cu ambele degete pe vene (Milking the veins)---distantezi (se golesc)---lasi degetul de joss au de sus—si vezi cum se
umple
Ciroza--paralel
Obstructie VCI—din ombilic spre periferie ca o stea---sangele merge in sus
Obstrcutie VCS- sus jos drepte,,,sangele merge in jos
Tromboze
Teleagiectazii
Echimoze
Grey turner
Cullen
Pustule--zoster
 Respiratie- normal in sincron cu toracele
Asincronism- Respiratie Abdominala Paradoxala—semn de isnuficienta respiratory

Auscultatie---deoarece se transmit foarte bine in cutia abodminala NU iti arata exact zona
Zg metalica- obstructive la debut, BII
Hiperactive/Borborisme- idem
Siletium- Peritonita
Ileus paralitic
Obstructii finale- oboseala
Ischemie intestinala
Altele-------
Sufluri Vasculare-
Zgariat Hepatic—
Frictions Rub---se atinge Tumor de perete
Clapotaj---succusion Slash—Obstructii, Dilatari Stomac

Palpare
Superficiala- mase, durere, ridigitate
Profunda- oranomegalie
Ficat- prinzi marginea inferioara coasta dreapta,, inspiri—nodulitati, durere
Lemnos- Tumoral
Ascutit-ciroza
Edematiat-nul prinzi—congestionat
Ficat Pulsatil
Regurgitare Tricuspidiana—cu Inspirul CRESTE amplitudinea
Pericardita Constrictiva---nu se modfica amplitudinea
Reflux Hepato Jugular
Murphy
Apasare ombilic
McBurney
Rovsing
Psoas
Obturator
Garnet—muscular/peritoneal
Testicular
 Aparare- contracture musculara la presiune
Rigiditate- Abdomen de lemn, aparare fara presiune, spontana
Rebound- durere la eliberare presiune
Tuse/Ridici capul- puncta hernieare

DD Masa intrabdominala si intrmurala----sa ridice capul-se contracta muschii car eIMPING in jos orice intrabdominal, DAR nu de perete

Percutie
Ficat----sus si jos pe linia Medio Claviculara VN pana in 13
Splina- Punct Castle Timpanism subcostal, in Inspir daca se face Mat= splenomaglie
Trauma
Hematom
HTP
Boli Hematologice
Infectii- Mono, HIV
Infarct Splenic
Ascita
Pneumoperitoneu
Glob Vezical
Distensie Intestinala

Speciale
Colecist- Murphy clinic/Ecografic

Pancreatiata
Cullen
Grey Turner

Apendice/Peritonita-
 Psoas
Obturator
Rovsing
Mcburney
Carnett sign
Testul Tusei
Valsalva
Cazi pe calcaie

Pielonefrita
Giordano

Hepatomegalie-
Liver Scratch test-

Leziune Splina
Kehr- durere umar stang
Balance sign- mataite stanga (Cheag) dar mataite decliva/miscatoare dreapta (Sange proaspat)

Hemoperitone
Cullen
Grey Turner

Sarcina Ectopica Sparta-

Cullen

Anevrism Ao
Masa pulsatile

Ascita
Semnul Valului
Matitate decliva
Colica cu senzatia de defectaie---- colica Intestinala Obstructie/Iritatie

Durere care se mentine—iritatie peritoneala

Nu poti sa dormi de durere==chirugical

Voma violenta---poate da un Sdr Malory Weiss—si Hematemeza

MEtroragii severe---Avort

Ameliorare
Alcaline, Mancare—Ulcer
Aplecat in fata –Ulcer, Pancreatita
AINS- musculoscheletal
Apa Calda—biliar
Trece cu scaun/gaze—Gastroenterita, Sdr Colon iritabil
Trece cu voma—gastrita, uler

Agravare
Miscare—musculoscheletal, peritonita
Tuse, inspire profund—peritonita localixzat..gen
Mancare—cancer gastric

Periferie
Hipocrate---ciroza, BII
Leconichia—hipoproteinemie
Koilonichia—deficit fier
Eritem palmar + nevi+Duypuitriene—ciroza
Asterixis—Encefalopatie Hepatica

Sclere—paloare
Icter
Xantelasme
Nevi pigmentari
Adenopatii supraclaviculare-
Fetor hepatic+ulceratii
Fetor cetotic + limba incarcata
Glosita-deficit Fier, Folati B12

Hidratare piele, exile, ochi

Abdomenul Acut
Dureer continua+ Soc= Pancreatita, vascular
Durere explosive+ Peritonita= perforatie viscerala- Ulcer, Diverticul, Apemndicita, Colecist, colon
Colica+ Voma+ Distensie + Constipatie= obstructive subtire, hernia, ileus

Cosntipatie+Distensie+durere+Voma—colon

Dureer severea la TUSE sau Inspir===cauza chirugicala

Spasm voluntary
Spasm involuntary—aparare adevarata---peritonita
Rigiditate—ca lemnul
Percutie uscoara---rebound
Dispare matiate Hepatica datorita Aer= pneumoperitoneu

Silentium—peritonita
Accentuate—obstructii

TR—iritatie Douglas peritonita

Mai ai de facut
https://clinicalgate.com/abdomen-and-gut-problems/