Its interesting when performing an exam on a patient and I ask them to “lay back”. The guys in their 30s or 40s look panic stricken… Until I reassure them that there is no rectal exam involved.
The exam is essential to discover underlying medical conditions and organ health. There are 4 quadrants or regions that we learn to examine in medical school. Here’s a brief breakdown
- Palpating below the breast bone- the stomach and esophagus meet there. Pain or tenderness in that region can indicate possible inflammation or ulceration.
- in the right upper quadrant we can assess the liver to make sure it’s not enlarged – if it is from cirrhosis we can usually look at the skin of the abdomen to look for other signs – veins sticking out with the appearance of varicose veins under the skin. Don’t forget the pesky Gallbladder. Some have pain on deep palpating, but others experience pain over their shoulder or between shoulder blades.
- Left Qupper Quadrant lies part of the large intestine and the spleen. The spleen can enlarge with Mono or with cancer.
- Right lower quadrant is home to the appendix and the connection between large and small intestines. For those who develop colon cancer in that region we may be able to palp are deeply enough to feel a possible mass.
- in the left lower quadrant, the beginning of the sigmoid colon – the space between the colon and rectum, is the most common site to have diverticuLITIS – depending on the amount of pain some patients need to be admitted to the hospital for IV antibiotics.
Now as an aside diverticulOsis (think holes) are the potholes in the colon that can become inflamed (-itis indicates inflammation).
6. In the middle of the abdomen near the bell button hernias can be felt. Not uncommon to see them in patients who work labor intensive jobs, do heavy lifting, have had prior abdominal surgery or in women postpartum. Usually repair is not necessary unless it’s for cosmetic reasons.
7. The main artery – the abdominal Aorta- can be not onlt felt in the midline of the abdomen, but occasionally placing our stethoscope over that area and listening can we hear abnormal sounds that might indicate enlargement of the aorta.
8. In women, the very lower abdomen is palates to ensure no ovarian pain which could be from cysts or even cancer.
Every part of the physical exam is important so arm yourself with knwledge before visiting the doctor with abdominal pain!
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