กก ก ก
4 ก ก ก flffiก ก ffl ก ffก
fffiกก fflกก ก ffl!ffl"ffl! !#$ffl% & &fflfl' ()*"+ffl ( impossible to accurately palpate the liver and spleen from the left side) ()ffi' #$ffl% (AffBC ffl&'D fi' &(AffBC$"ffl & flffffl#$ffl% fl' E
ก ก ก"$fiกFGHfiHกI" !#$ffl% ffi A'FH ffffl #C ff !!fiHก E HAND, NAIL & SKIN CLUBBING OF FINGER - &*("fflfffiI ffi !\, malabsorption, chronic diarrhea from any causes, congenital cyanotic heart diseases, infective endocarditis, CA lung ffl
CLUBBING OF FINGER
CLUBBING OF FINGER
LEUKONYCHIA ( TERRY ’S NAIL ) fi\! - ffi' &'I'flfi"`ffi !\ KOILONYCHIA fi\ff&ffiffl - ffi' &'fi"กก!"aDfffi\ก HYPERPIGMENTED SPOTS ' BUCCAL MUCOSA/PALM I Peutz-Jegher ’s syndrome
KOILONYCHIA
ACANTHOSIS NIGRICANS (fl DM, obesity ff GI malignancy LEAD LINE D""`EC Gกhi I"j(H ffDก fffiffl ffi' กC" H(CFก Hก SIGNS OF SCLERODERMA SALT & PAPPER APPEARANCE OF SKIN SCLERODACTYLY
ACANTHOSIS NIGRICANS
SIGNS OF CHRONIC LIVER DISEASE PALMAR ERYTHEMA &*("fflfl rheumatic heart disease, pregnancy, rheumatoid arthritis, chronic leukemia, thyrotoxicosis ffl DUPUYTREN ’S CONTRACTURE I"j(H ffDกfffiffl กC"ก fibrosis ! palmar fascia
PALMAR ERYTHEMA
SPIDER NEVI (fl ' ), thyrotoxicosis, rheumatoid arthritis, estrogen intake n ffl"$ &'C&Gfl"*n&' & ` B PAROTID GLAND ENLARGEMENT I"j(H ffDกfffiffl GYNECOMASTIA (flก"ffl spironolactone, cimetidine
Spider nevi
Gynecomastia
Gynecomastia
SIGNS OF HEPATIC DYSFUNCTION FLAPPING TREMOR (ASTERIXIS) ("fflfl uremia, CHF, CO2 nacrosis SKIN BRUISING ( PETECHIAE & ECCHYMOSIS )
SIGNS OF DYSLIPIDEMIA XANTHOMA & crease !q%& กก H &! cholesterol fl chronic cholestasis ffi PBC ff chronic obstructive jaundice XANTHELASMA
Xanthoma of palmar crease
Xanthelasma
ก flffiกfiH 1 SIGNS OF HIV INFECTION ORAL CANDIDIASIS ORAL HAIRY LEUCOPLAKIA PPE
Oral candidiasis
Esophageal candidiasis
Oral hairy leukoplakia
HIV WASTING
KAPOSI’S SARCOMA
SIGNS OF VITAMIN & NUTRITIONAL DEFICIENCY - ANGULAR STOMATITIS - GLOSSITIS fiC &" กก!"Ihfiff B12 - ATROPHIC GLOSSITIS fiC fi' กก!" aDfffi\ก ก flffiกfiH 2
PHARYNGEAL ENLARGEMENT fl LYMPHOMA &' GI involvement of lymphoma MACROGLOSSIA fiC I (fl amyloidosis TELANGIECTASIS ' oral mucosa fffiC (fl Hereditary telangiectasia ( Osler Weber Rendu disease ) BREATH FETOR HEPATICUS CERVICAL LYMPH NODES(All 8 groups esp VIRCHOW ’S NODE : left supraclavicular LN ) ก flffiกfiH 3
Telangiectasia
ก ffl flffifflfffiก"$ hi H fi` ( ก HfiH fi` `flffffl 'ก fiff !fi` fflfi'fi ) ffl$ffl Anatomical landmark fiH BOUNDARIES: COSTAL MARGIN, XIPHISTERNUM, INGUINAL LIGAMENTS, FLANKS, Mc Burney ’s point ($' 1 3 ! ffl'fiกก ASIS H")
Anatomical landmark
ffl$ffl normal variation ("ffl กก"$ ก fiff !fi` fflfl #& กffl! aorta 'C GfiC xy กกhi 'ก fiff !fi` ffl (peristalsis) 'fflffl (borborygmi)
กก H tympanicity กกz C GกH(Hff fiHfi` ffl กก fi` LIVER fi`"ffl*fflfffl!fflfinก E I"j(Hfl COPD ! fi fl #& AORTA &' pulsatile fl #& COLON descending & sigmoid colon I"j(Hfl ffl#$ก BLADDER กG' full bladder &"fi$ก (!GH )) ffl$ffl normal variation ("ffl
Normal variation ' ("ffl
ก"$ ANY SCARS, STRIAE, DISTENSION, CONTOURS, UMBILICUS, SUPERFICIAL VEINS, PULSATIONS, VISIBLE PERISTALSIS Umbilical LN ( SISTER JOSEPH MARRY’S NODE ) *n GI malignancy VISIBLE PERISTALSIS (fl gut obstruction ff #&&ก E SIGNS OF HEMORRHAGIC PANCREATITIS CULLEN’S SIGN GRAY-TURNER’S SIGN
Sister-Joseph-Marry LN.
Sister-Joseph-Marry LN.
ABNORMAL VESSEL SUPERFICIAL VEIN DILATATION o CAกCAก H" portal hypertensioon o C!n fi" IVC obstruction BACK VEIN o IVC obstruction SUPERFICIAL VEIN DILATATION AND VENOUS HUM AT AREA Hff epigastrium fiH umbilicus (fl Craveilhier Baumgarten syndrome congenital patent of umbilical vein &' H portal hypertension
ABNORMAL VESSEL
ABNORMAL VESSEL
กhi Bowel sound ff peristalsis H"fflCDก 2-10 C' fflก normoactive, hyperactive or hypoactive Vascular sound: bruit, venous hum Splashing sound (Succusssion splash) *n gastric outlet obstruction fflfl #$ffl% NPO H&G 2-3 ffi I&
fffi !"# $ %&ก
ก H ก (ff!"! Hff ff &' ascites ff& ก Hff!" H : span 12.5 cm. fl MCL Hก I ffn "!"fl vertical &ffl& : กG''&ffl&I&&ก HC Gffi+'กI ' `' D"fl AAL !ffl+ffl กCHI ff Hfffl!ffl fiHก\&' กG'&ffl&IH H"fflnก&ffl&HI& "fflfifiH"fflfl
ก H&ffl&
ก H&ffl&
SHIFTING DULLNESS "ffl&&' `กC ก 1 fiC FLUID THRILL PUDDLE SIGN กG'&' `ffl 200 +'+' I" ก HfiHhi &ก ก Ascites
SHIFTING DULLNESS
PUDDLE SIGN
ก H(ffกz fl"Cff flffBH HI (tympanic) &&'fi&flfi` ffl ffflffl&กก กCH H"ffl ' I&ก (hyper-tympanic) *fflกfflff `H H"ffl 'n (hypo-tympanic ff dull)
ก H("$ loss of liver dullness " &'!"fi\กfiff&'กz flffl กHfi& ffi Hollow viscus perforation fffl กz !fflflffiffl(ก กF