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VENOUS TUMOURS Venous malformation cavernous angioma/haemangioma These malformations are common, representing one end of a spectrum of arteriovenous malformations. They often a ff ect the skin but also extend into the deep tissues, including bones and joints. ...

Abdominal pain Pain is the most common of all abdominal symptoms and may be due to inflammatory , infective, obstructive, neurogenic, neoplastic or ischaemic pathology . Sometimes no organic cause can be found, a situation often labelled as ‘functional or - no...

Auscultation High-pitched bowel sounds are heard during the early stages - of mechanical intestinal obstruction. Aortic and iliac bruits are heard when blood flows through a stenosis. A succussion splash is a sound like ‘shaking a half-filled bottle with water’...

CLINICAL PRESENTATION OF ABDOMINAL PROBLEMS Pain, weight loss, anorexia or vomiting, jaundice, abdominal bloating/distension, presence of a lump, alteration of bowel habit and blood loss or anaemia are the common clinical presentations of abdominal pathology...

EXAMINATION OF THE ABDOMEN Abdominal examination must be preceded by a detailed general examination of the patient as a whole. Physical examination should be systematic using the following sequence: inspection, palpation, percussion and auscultation.

FURTHER READING Das S, Das S. A manual on clinical surgery, 14th edn. Kolkata: Das Pub - lications, 2019. Lumley JS, D’Cruz AK, Hoballah JJ, Scott-Connor CE. Hamilton Bai - ley’s demonstrations of physical signs in clinical surgery, 19th edn. Lon - don: CRC P...

GATHERING INFORMATION The experienced clinician will recognise the acuity and sever ity of the patient’s condition even before a history has been taken. Initial observation provides clues to the direction that the history should take: general appearance, gait...

General examination The patient must be lying flat with hips and knees extended but without causing distress (this may require provision of a pillow) and the abdomen should be adequately exposed. palpation hips and knees are flexed to ensure relaxation of abdomi...

Inspection of hernia sites, examination of genitalia, inspection of anal region and digital rectal examination Abdominal examination is not complete until all external hernia sites and the anal area have been carefully inspected, are examined and a digital rec...

Inspection Scars, abdominal distension, visible peristalsis or abdominal masses, dilated veins, pulsation or abdominal wall swelling suggestive of hernia should all be carefully sought. The size and location of scars from previous surgery may provide some in...

INTRODUCTION Abdominal symptoms are a frequent cause for surgical consul tation. The underlying cause may be acute, presenting with the euphemistically termed ‘acute abdomen’; subacute, indicating an evolving disorder; or longstanding, suggesting a functional ...

Learning objectives To learn: The art and science of history-taking in a patient with • abdominal complaints To be able to: Recognise the organ or system responsible for the clinical • features

Obstruction Central colicky abdominal pain is a classic presentation of small bowel obstruction. The central distribution is because of the segmental nerve supply of the midgut. When the peristaltic waves hit an obstruction, the contractions increase to over ...

Obtaining a history Presenting complaint To establish the presenting complaint one should start with - an open question inviting the patient to explain the reason for seeking medical advice. The patient must be allowed to explain the presenting complaint witho...

PATHOPHYSIOLOGICAL BASIS OF COMMON ABDOMINAL SYMPTOMS AND SIGNS The abdominal wall and parietal peritoneum are innervated by the somatic nervous system, whereas the abdominal organs and visceral peritoneum are innervated by the autonomic nervous system. Theref...

Palpation Palpation should be performed in a systematic manner, check - ing all nine regions of the abdomen ( Figure 63.2 ). Palpation should start in the region furthest away from the site of pain and the patient instructed to let the examiner know if tend...

Percussion Percussion helps to distinguish distension due to bowel gas from solid masses and free fluid in the abdomen. Percussion is most sensitive when the examiner moves from resonant parts of the abdomen to dull areas. In patients with free fluid in the per...

Rupture and perforation of organs The urinary bladder, gallbladder and gastrointestinal tract are hollow organs that contain fluid. The gastrointestinal system also contains faeces, air and a high concentration of organisms. Trauma, ischaemia or tissue ulcerat...