Full transcript
0:00[Music] so scalp appears to be healthy overall no concerns with that okay so if it's all right with you we'll go ahead and move on to the abdominal examination so what I'm going to do is
0:21move your shirt slightly upwards just exposing the abdomen also lower your shorts I'm going to go ahead and cover you provide you with a little bit of modesty so I'll
0:42just be undoing the top button here I'm going to fold these in just
1:04is that comfortable for you just taking my penl and having a look the skin overall
1:30notice a small mole there this appear to be a normal in texture and color slightly [Music] raised but margins are normal does appear that you had your
1:52belly button pierced at one point not noticing any signs of scar tissue just having a closer look at the umbilicus does appear to have
2:12healed normally into adulthood I'm not noticing any signs of umbilical hernia and hair distribution is normal and even throughout no signs of excess feminine hair growth or any signs that could Le to an abnormality
2:34in your hormones which is good okay so let Begin by listening to your stomach so just have my stethoscope here and it is a little cold I apologize
2:56but you're going to feel me place this on your stomach in various position positions being sure to listen in all
3:16four quadrants
3:36listening to the large intestin as well as the small okay
3:57perfect so bell sounds are normal and active no signs of overactivity blood flow appears to be normal let's go ahead and move on I want to do just a couple of measurements here checking for any asymmetry in the
4:21umbilicus and of course these measurements assist with being able to record your BMR
4:45okay okay so let's move on to some palpations of the abdomen so you're going to feel me very gently at first palate around for
5:37so I'm going to go a little bit [Music] deeper let me know if any of this causes you any discomfort
6:14Mak sure to palpate around the umbilicus or belly button again checking for any signs of umbilical hernia
6:40you're going to feel me palpate slightly deeper checking any palpable organs such as your kidneys spleen
7:04Lum n of which are palpable which tells me there's not any signs or symptoms of inflammation
7:36listening for a hollow sound above the umbilicus present and normal let's go ahead and move on to a series of bra sensation tests should be able to feel that this is soft
8:07and this is sharp checking for any L of sensation on your Scar Tissue but I don't notice any I'm getting a normal
8:27reaction around the umil which is good going to move on to bit of a more prominent test so testing your sharp sensation just looking for signs normal reaction which is
8:48[Music] present can see the flexing of the abdominal muscles
9:21again see normal flexing of those accessory muscles may be testing for cold temperature sensation so this should feel very cold
10:22okay more reaction
10:58that kind of abnormality here just want to make sure again we getting a normal reaction in
11:23those accessory muscles here
11:47okay so let's go ahead and get started I'm just going to start with the visual inspection so just taking my penl and having a look at your stomach looking at your breathing as well as your skin so far everything appears
12:08normal do have a couple Freckles but they look fine they're not raised or asymmetrical in shape skin color and texture is normal for age and ethnicity which is good and you do not appear to be dehydrated okay umbilicus appears normal
12:31doesn't appear that you've ever had your belly button pierced never and I'm not noticing any sense of complication at Birth so that's good okay no visible stretch marks or any other abnormalities of the skin okay so overall you look healthy
12:54let's go ahead and get started with some palpation so again I'm going to be using two to three fingers and you will feel me kind of gently at first pushing around on your abdomen okay yep so just getting started with a few gentle [Music] palpations
13:19per is soft and tender not noticing any abnormal firmness or any signs of bloating just going of fell at the base of your breast bone which appears to be intact and I am able to palpate your
13:42ribs normally pain or tenderness here and are you having normal bowel movements when was your last Bal this morning and it was normal no diarrhea or anything okay and are you ever constipated definitely not noticing any
14:04signs of bloating so your diet appears to be working for your digestive system so now you're going to feel me palpate a little bit deeper this time I'm feeling for your organs okay this might feel a little odd
14:39keep
15:04just feeling for your intestines I'm going to be pulling up here pal painting a little deeper just looking for any signs of umbilical hernia which would be a hernia below your belly bone but I'm not noticing that right okay so I'm going to take my stethoscope and have a listen to your
15:27Bells it's going to be a little cold
16:00okay so bow Sands are
16:25active can I have you breathe in deeply and then hold your breath okay and release and one more time release very good okay no issues there b sounds are normal you appear to be
16:47digesting your food normally and I'm not noticing any other abnormalities so I am going to take my reflex hammer and you'll just feel me do kind of a light top along your belly okay
17:20okay I'm sure you can hear that Hollow sound is what we're looking for okay very good and then is there any pain or tenderness as I kind of percuss along your rib cage here
17:41no very good so for the last portion of your abdominal exam I'm going to be performing a sensation test so I'm just seeing if there's any issues with sensory loss um or any abnormalities from one side or the other that could indicate a neurological dysfunction okay so to start I have just a cotton wisp
18:02here it's going to feel like this I'm going to run it along your stomach at first you don't have to say anything I'm just looking for a normal reaction in your muscles okay so it might tickle just a little
18:28perfect okay so now if you can I'd like you to close your eyes and as you feel it touch your skin I just want you to say yes okay yes yes yes yes yes yes yes yes yes yes perfect so we're going to do the
18:50same thing this time you're going to feel this side which is a little sharper so just say yes when you feel it yes yes yes yes yes yes yes yes yes yes okay sorry I know that is pretty ticklish so this time we're going to
19:11alternate sides so this will be soft and this will be sharp and you just indicate which side do you feel okay soft soft soft sof harder
19:32harder soft soft hard hard soft soft hard soft very good okay I get those right you got all of them right you did very well a little hard so moving on from that we're going to do something
19:53similar this time I have what's actually an acur pressure tool but you're going to feel me just press it into your skin I might do it softly I might do it a little deeper just say yes if you would okay yes yes yes yes yes yes yes yes
20:14yes yes yes yes yes yes very good now this test is a little bit harder if you don't get it correct it's okay can you feel the difference between this point and this one I don't know if I can feel it so one is just a little more surface area so
20:35this one is smaller and this one is larger so this will be one and this will be two if you can't tell the difference don't worry about it okay okay two two two two two
20:55two two two okay that's okay that test is very difficult so you weren't able to tell but that's all right so we're going to move on and this time I'm going to be using what looks like a pair of tweezers so I'm going to do a light very gentle pinch and I want you to just say yes
21:16okay yes yes yes yes yes yes yes yes yes yes yes yes very good no issues with that all right Katie so let's go ahead and move on so this time I have a little
21:38brush and I'm going to brush this along your stomach and you just say yes if you feel it I will warn you this one is usually tickling people so just want to let you know yes yes yes yes yes yes yes
22:06yes very good so I did get a normal reaction there and now I'm going to move on to the wartenberg wheel which is probably the most ticklish of the bunch so it is pretty spiky it's not going to hurt you but it is a very distinct sharp so you'll feel me running along your skin I want you to tell me if it feels
22:24any differently from one side to the other so I'll do it on one side and then the opposite and you you just let me know if it doesn't feel the same okay so this side compared to this side does that feel the same yeah tickles more over here more on this side okay and
22:44here and here same same here here and then if we do top bottom same and then kind of midline top bottom same and over your belly button is not any more sensitive
23:05than anywhere else correct more ticklish here yeah on the sides I would imagine yeah compared to here yeah okay very good so now I'm going to use an object that's fairly cold can you tell that that's cold yeah so I just want you to
23:25say yes if you feel it and gets any warmer yes anywhere on your stomach yes yes yes yes yes yes yes
23:47yes yes yes perfect and can you feel vibration here no I don't feel vibration I feel you touched me though do you feel vibration here yeah here not
24:09really no but you feel that it's cold yeah okay I felt vibration that time okay so you feel this and it stops as it touches you yeah okay that's fine so you're just a little more sensitive in your hands than you are in your belly but you are able to feel it so that's okay okay and then the
24:28last thing I want to do is I'm going to use the end tip here and you don't have to close your eyes I'm just going to run this along the middle of your stomach and I'm just looking for a reaction in your muscles okay okay react the side there we
24:49go getting a normal reaction there very good okay so let me just jot down a couple of notes here and and we will go ahead and move on to your pelvic exam after this okay okay so I didn't notice any abnormalities in your abdomen bow sounds were normal sensation test was
25:11perfect you missed a couple but there nothing that would be considered AB normal okay it was a kind of hard test it is kind of difficult you don't you you get touched in your stomach but not in that way by other people so it can be kind of odd it's hard to tell the difference as far as when I do it on your hands you're
25:30more likely to know what it is but on your stomach it is difficult yeah okay all right so I am going to go ahead and get set up for your pelvic exam now as far as atmosphere in the room I did want to get it set up to your preference
25:50just so you can be comfortable because obviously it is an invasive exam so when you filled out your appointment card you did say that you preferred pink or purple light so I will accommodate that you've asked for dim lighting with a candle which I do have and then you wanted a melon scented satchet which I do have and I will give to you before we
26:10get started okay okay okay so let me get all of that set up for you and then we will come back and we'll get started and I'll explain the rest of the exam okay thank you perfect so the next portion of the exam is going to be abdominal okay so I will be having a look at your stomach y can
26:25you take my shirt off or um I will list it up for that's all right or we can just LIF it up to your chest and then I'll make sure you're covered down here with this sheet um so just like that should be fine okay and then we'll just kind of Tuck this in is that okay like that yes fine
26:44perfect okay so first what I'm going to do is just have a listen to your abdomen definitely want to listen for any excess bowel sounds um any overactivity of the bowels blockages in your intestine anything that could indicate like a small bell obstruction y when is the last time you had a bell movement uh yesterday last last night I
27:06guess it's last night okay and is that normal for you yeah it's usually weird but it's like it's like like 9 between 900 and 1100 I think I go to the bathroom like one more time so most people's bodies do adapt to a schedule and you start to go at the same time every day so that's good that
27:22there's not been any changes with that bow sounds are normal I'm hearing normal activity it does sound like you're digesting some food now you eaten within the last 5 hours yes okay
27:48good so I'm just going to place this directly over your belly button just listening for any umbilical grys can I have you breathe in deep hold the air in your belly
28:09Y and release very good and while I have this out I'm just going to do some light percussing
28:32good what is that what does that do that was just kind of percussing your intestines to see what feedback they give me listening for a hollow sound so anything that might sound rigid or stiff might indicate a ball obstruction which would mean you have stool sitting that's not passing through yeah so no indication of
28:52that so let's do a quick test for symmetry I just have a ruler here yep I'm just going to be making sure that you aren't experiencing any abnormal bloating or swelling do you feel bloated more than usual um not really no
29:22okay okay so you're fairly symmetrical from side to side just going to take my calipers can I have you breathe all of your air out protrude your belly as much as you possibly can and now bring it in as far as you
29:43possibly can good so do that one more time out out out and go in as far as you can good okay that is all normal so the next thing I'm going to do is test for
30:04reactivity of your skin so you're going to feel a slight kind of pinching with my tweezers it shouldn't hurt but you definitely will feel it you don't have to do anything here I'm just testing for normal reactivity in your muscles so this basically sends a signal to your abdominal muscles and we're
30:24seeing that normal reaction and then this might be a little uncomfortable I'm going to very slightly tug on the hair here good okay all right Anthony so that's all right with you let's go ahead and move on to a brief sensation test okay and just
30:45looking for normal sensation of the abdomen so I'm going to do that by testing a couple different tools here so for the first one I do want you to close your eyes tell me when you feel this soft sensation okay y I feel it feel it I feel it I feel it felt it okay and now when you feel sharp sharp right there
31:08y feel it good okay I apologize I know it's tick aish so I'm going to do a very brief sharp or dull I want you to just tell me which one you feel uh sharp uh wait uh I was said that was Shar the first one was kind of dull okay uh
31:41D sharp sharp sharp sharp sharp that was D okay that was D okay so there were just a few that you got incorrect but you were able to guess at the next turn around okay this next one is a little scratchy but still soft so I
32:01want you to just say yes when you feel it yes yep yes yes yes yes any difference between this side and this side uh no okay very good the next one I'm going to do is this light brushing so this is
32:21going to rule out any signs of neuropathy I want you to tell me if this feels abnormal any stinging burning anything like that okay okay and this one is called a wartenberg wheel it's fairly sharp I'm going to run this along your belly in different directions I want you to tell me if the
32:43sensation changes from one side to the other so ideally it would feel the same bilaterally which means both sides should feel the same okay feel same the same okay feel the same and here and
33:04here is the same y all around the umbilicus is the same yep perfect and if we go horizontally that's the same yeah yeah I think my stomach's like used to like the sensation so keep like contct that's good though so we're getting normal reactivity in the muscles of your abdomen which is what we want to see if there was a lack of reaction or
33:25even an overreaction then could indicate a bigger problem so totally fine so I'm going to do some just prussing here and just listening to the four quadrants of your abdomen so you can tell that this here sounds different than this and that's what we want to listen
33:51for I'm going to do one here just on your breastplate and then along your chest wall can I you say 99 every time I tap 99 99 99 99 here 99 99
34:1599 the last reflex test I want to have I'm going to do on your abdomen is I'm going to have you close your eyes and I'm going to run something along your stomach and I want you to just let yourself react normally mhm
34:35good okay I know that's very tickl but we did good a good reaction there so the last sensation test I'm going to do here is just have you tell me if this feels cold yeah does this feel warm yes okay so just tell me cold or warm warm cold cold warm cold cold cold
34:59and same coldness all the way across here okay thank you so I'm going to do some deeper palpation now so you're going to fill me press in tell me if any of this gives you any discomfort or a little bit discomfort here here not so much a little bit there
35:21a little bit here yeah okay so I am feeling some slight bloating in your lower eye opom it's like sometimes I like like I feel the pressure okay how's your water intake been in the
35:42last few days uh it could have been way better honestly I think um sometimes I overcompensating like like the Gatorade um but I know I need to I should have drink more water okay so that makes sense if you've been drinking more Gatorade than water um there's definitely a little bit of swelling here which could be the salt
36:02intake Gatorade is pretty high in sodium and if you haven't been drinking water so you're dehydrated and you're also retaining water which explains the bloating and why you're a little uncomfortable here um you're just a little fo so I would hold off on the Gatorade lighten up on the sodium intake whether that's food or drink definitely
36:23drink some more water try drinking some lemon water okay I'm not too concerned because you are having normal bowel movements bow sounds are normal but I do want to make sure that we're preventing any further damage so I'm going to guess that this is likely a food poisoning incident
36:47okay um if it were a virus I would think you would be having more diarrhea more vomiting because your body is not going to get rid of the virus until you expel all of it unfortunately with food poisoning normally the sicker days come within the first 1 to 3 days after you consume the food and then it kind of
37:06tapers down after that where whereas um I'm sorry whereas with a virus it'll kind of last all throughout until it's completely done so I'm guessing that this is a food poisoning incident um unfortunately you don't know what it was so I would just be careful with where you're eating likely wasn't something you had at home most people
37:25don't get food poisoning from their own kitchen would would undercooked food give you absolutely yeah yeah I think I had some um I could took it from my job I don't think it was like it wasn't hitting maybe not fully cooked okay and chicken unfortunately is one that has to be cooked completely to 160° otherwise you're looking at risk of salm vanilla
37:44botulism that kind of thing okay okay was it dark meat chicken by chance okay so dark meat is harder to tell because it's kind of pink throughout so even if it's fully cooked it still has aink tinge versus if you're eating like a breast or white meat you can tell whether or not it's fully cooked um so definitely something to
38:04look out for also undercooked chicken has a specific smell versus if it's fully cooked um so just something to keep in mind definitely and you did say that other people at work were sick as well so they probably likely ate the same thing okay that's all making sense okay concerned today so I think we're
38:24good to go as far as the breast exam so that's wonderful new news so let's go ahead and move on to your abdominal assessment and like I said I just want to have a brief look at your abdomen make sure that there's nothing concerning no signs of inflammation in your pancreas or anything like that okay so I am just going to slide this
38:47down okay so I'm just going to tuck this underneath your belly button and we only need just a little bit of exposure here enough for me to just have a look at your abdomen so I'm going to start with some oscilations so I'm going to use my stethoscope to listen to your heart as well as your belly make sure that
39:09everything sounds healthy and is functioning within normal limits so this is very cold I do apologize I want you to just take a couple regular breaths for me to start okay
39:38so far everything sounds normal
39:58okay so I'm not hearing any cause for concern there so I'm going to move down and listen to your abdomen now okay so again just take normal breaths for
40:22me perfect good good good so I have you take a deep breath in for me perfect one
40:48more I'm going to listen right over your belly button and I'm listening for any signs of unbilical hernia so I'm just going to pull this down slightly here so I have a little bit better
41:09access I'm not hearing anything concerning here good okay so all of that sounds
41:33healthy so we go ahead and put this away and we can move on with the next portion of our examination so I'm going to start by just having a look with my light just like I did to your hairline just having an overall look making sure nothing looks abnormal there okay just using my light to cast a
41:53natural Shadow here looking for any signs of anything that could be protruding any signs of abdominal hernia anything like that it does look like at one point you had your belly button pierced is that still an active piercing no not anymore okay do you know if the hole is open or has it closed I'm not sure okay I'm going to just have a look
42:12and see if there's any signs of infection or anything there okay when is the last time you had a piercing in place a long time ago a long time ago okay so at least a couple years so it does appear that as though the piercing might still be
42:34active I definitely would be careful if for whatever reason you do decide to insert a piercing it could be closed in the very center so I don't want you to hurt yourself but it does appear as if it might be still active okay it is still open on both the opening and the closure no signs of infection or anything otherwise AB
42:57normal there though I'm also not noticing any Scar Tissue no signs of choid or anything like that okay and the belly button itself does appear healthy there's no signs of excess debris or anything like that skin itself is well intact
43:19smooth nothing notable concerning here okay okay so I am going to move on to some gentle palpations so I'm just going to be using three of my fingers to palpate around your abdomen here okay so
43:40starting here gently feeling on top of and underneath your rib cage any pain or tenderness here okay good and on this side no pain or tenderness
44:01here so just starting off with a gentler [Music] palpation okay all goes normal
44:27going with a little bit of a deeper palpation here this time I'm feeling for your organs okay so I'm not feeling any signs of excess inflammation or anything that
44:48would indicate any abnormality within your organs all of that feels completely normal okay so the next thing I'm going to do as far as your abdominal exam um is just do some gentle percussion so I have a couple different devices here that I will be using and it's just kind of a gentle tapping to just kind of feel
45:08around listening for any signs or symptoms that there could be an abnormality there so so far that sounds normal any pain or tenderness in the belly here no
45:34again button here no pain or tenderness here okay good so just going to repeat that test with a very small hammer and this is going to do the same thing just very slightly different this time I'm going
45:55in a diagonal motion okay and then again along the ribs here
46:18there's no pain or tenderness gotta and nothing along the belly button here good okay so the last thing I'm going to do for your abdominal exam it's just a very brief test for
46:40normal sensory response so you don't have to do anything I'm just looking for a natural neurological function basically you have reflexes in your abdomen that will Flex a certain way reflexes in your skin and I'm just looking to make sure all of that is intact based on what stimul I produce on the skin okay so just close your eyes
47:00for me allow yourself to react naturally good good good so you I'm seeing
47:20thetion of the muscle there doing very well good I know it's a little tickl you're doing
47:50great good going to do that with my second tool testing for temperature variation here perfect getting a great response
48:37I'm going to go ahead and test that with a different tool
48:58okay
49:30good so all of that have a normal neurological response and I don't see why there's any cause for concern as far as your breast exam or your abdominal assessment I would say we could probably go ahead and move on to the examination of your back so I will have you turn around um onto your belly and then we'll
49:49assess your back okay okay okay very good we do a b so at this time I am going to go ahead and move on into the abdominal assessment so you just go ahead and relax I'm just going to have a look at your belly as well as your pelvis I might manipulate your clothing just slightly to kind of give me a
50:06little bit more of a viewing area you just let me know if any of it causes you any discomfort okay perfect so just to start off with I'm going to go ahead and expose a little bit of a wider area here so just bringing your top up to about the RO
50:27wall so that I can expose your rib cage here and have a better look and then as well as very slightly pulling down your bottoms so that I can have a look at the umbilical area as well perfect okay so now that I have good visualization of the area as a
50:47whole I will go ahead and start with my assessment so I would like to just have a look kind of overall notating any changes or abnormalities in the skin skin texture so skin appears smooth as a whole not noting any areas that are
51:09abnormally bumpy or anything that can indicate an underlying inflammatory conditions such as psoriasis or eczema you see a very small mole here that I will have a look at more closely as a whole your skin is very very clear does appear that you had a belly
51:31button piercing or an umbilical piercing at one point so I will have a look at that just pulling the skin slightly tat so that I can have a look underneath noting any visible veins
52:20also noting the curvature of your rib cage on both sides checking for symmetry there there of course having a look at the umbilicus here noting any possible abnormalities externally but I don't see
52:40anything there so I'm going to go in with a little bit of a different light so this is just a variation of a pen light and it's just going to allow me to have a bit of a closer look at your skin so I'm going to begin by shining it kind of directly here so that I can just have
52:59a look at the overall skin integrity
53:29so nothing of note here as far as I can tell skin texture is very normal everything looks healthy does appear that you are slightly cold as I notice some Goosebump here but that's okay and then just having a little bit of a closer look Excuse me while I just get slightly
53:51closer here I just want to look at this MO so it's not raised in texture at all which is a good sign and color is normal and consistent with your natural skin tone so what we like
54:12to see with moles is that they're only a couple of Shades Darker than your natural skin tone it does become a little bit worrisome if they are black around the edges or darker than what we would like to see so as far as I'm concerned this is is not anything to worry about here like I said it's not
54:30raised away from the skin at all and while the edges are slightly abnormal um it's nothing that I would say is concerning it does have a circular kind of oval pattern to it which is good so I wouldn't guess that that's
54:51anything that we need to worry about so I'm going to have a little bit of a better look at this belly button piercing and did see in your chart that you said this was no longer an active piercing so at this point we wouldn't really be worried about any signs of infection as it has been closed for some time do just
55:14want to make sure that there's no signs of abnormal scarring or choid thickening of the skin anything like that which I did not know upon visual inspection so just going to have a little bit of a closer look here with my brighter light [Music] and not noting anything abnormal
55:38here also it does not appear that the piercing is active meaning that it no longer goes from the opening to the closure it does appear that the scar tissue has closed it throughout the middle so if this was a piercing that at any point you wanted to use again and you would likely have to have it repierced
56:00okay all right so let's go ahead and move on to some palpations of your abdomen so what I would like to do at this time essentially is similar to what we did with your chest and clavicle area so just going to push this down a little further and begin by having a look
56:24here so so looking for symmetry in your breathing so when you breathe in we'd like to see even rise on both sides of the abdomen which I am noting so just watching a couple of your
56:46respirations making sure that I'm not noting any abnormality there all of that does appear to be within normal limits so what I'm going to do actually is go ahead and have a listen to your abdomen so so I'm just going to go in with my stethoscope and is a little bit cold I
57:08do apologize but I'm going to place this on various areas here and just have a listen to your stomach so going to get just a little bit closer here and just kind of gently place this down so that I can hear your abdominal sound and
57:29listening for normal activity in the colon also listening to make sure that your intestines appear to be functioning properly so we would like to hear some activity in your bowels
57:59making sure that everything sounds okay and that I'm not hearing any overactive bell sounds which could indicate something wrong with your endocrine system but I'm not noticing that so far doesn't appear that you have any underlying diseases such as
58:20Crohn's or any other abnormalities with your stomach and your Digest digestive system
58:57this just so normal then am just going to place this directly over your belly button I'm just listening for any signs of umbilical hernia there's any more opaque areas that I'm not able to hear but that does sound normal as well very good okay so
59:20lastly just going to flip over to the Bell side and have a listen one more time
59:43perfect okay the good news is that all of that was well within normal limit so nothing to worry about there just going to go ahead and put my stethoscope back on its holder and I am just going to go ahead and notate that
1:00:04your abdominal oscilations were normal bell sounds were active but within normal limits I did not know any over activity okay all right so let's go ahead and
1:00:24move on here and and as I stated before I'm just going to be doing some palpations of this area so just going to start by palpating around your rib cage here so just going to first kind of map out this area [Music]
1:00:45and just feeling for the protr of your ribs here so this is a very natural kind of line of demarcation that's notable here along your rib cage as well as on
1:01:07this side and I'm just kind of placing my hands in a motion that allows me to go underneath so that I can feel the ribs more easily individually so I'm just going to be palpating along and this might be slightly uncomfortable but shouldn't cause you any
1:01:44pain okay and then being sure to Pate along the edge here good do that on the other side as well you're doing great
1:02:26so all of that appears to be normal I'm not noting any inflammation on either side and they do appear symmetrical in shape as well as where they end on your abdominal wall here so the quadrants of your abdomen they end up right about the same spot which is what we like to see so what I'm going to do now is just come
1:02:48a little bit closer here so that I can palpate along your chest wall down to the sternum so just pting down this area putting a little bit of a deeper pressure in between the rib cage I'm going to follow that all the way down to your
1:03:12umbilicus and there's a notable change in texture along your chest wall as we come down so the further down we come the more fat deposits you have in your abdomen which is totally normal we just like to see that there is a change in the fatty tissue here versus
1:03:35here good okay so I'm going to palpate now coming from the outside working my way in
1:03:56and now top to [Music]
1:04:20bottom perfect okay so I'm going to go ahead and palpate directly along your belly button now and just going to hold the skin slightly taut here and just palpating around in a circular motion making sure that I'm not noting any further signs of umbilical
1:04:41hernia so all of that does appear to be normal no notable abnormalities in texture
1:05:26all right Isabelle you're doing really well so what I'm going to do at this time is proceed with some more percussions of your abdomen so using the same tool that I used along your chest wall just going to be percussing essentially the same way just listening for any abnormalities in sounds with oscilation here
1:05:58so first working along the rib
1:06:20cage so there's of course a notable difference in sound in the more bony prominent areas here so there's more bony prominence the sound is more kind of hollow versus when we get to these higher fat concentrated areas the sound is a little more dense which is what we
1:06:41like to see
1:07:13good perfect okay so all of that was well within normal limits I think what I would like to do at this time is move on to some palpations of your pelvis so what I'm going to do is I guess I can leave your pants where they are I'm just going to bring down
1:07:33this fold I'm just going to be palpating along the pelvic bone here so just looking for any [Music] abnormalities in the pelvis itself
1:08:02so your pelvic bone protrudes to the very top portion here and then as well as the bottom portion of your abdomen so just making sure that all of that is symmetrical and normal from one side to the other making sure there's no notable signs of
1:08:22asymmetry anything that could indicate either a dislocation of your pelvis or maybe just a something that would indicate that you would need a realignment um which would be taken care of by a chiropractor but so far I'm not noticing that so what I'm going to do now is do just a little shimmy of your
1:08:43pelvis and this is just going to further allow me to not any signs of dislocation and all of that was normal so I'm just feeling right above the
1:09:04bladder and looking for any signs of possible infation or enlargement so looking for any signs of enlargement in the bladder itself which I'm not noting does appear to be normal in size and shap noting
1:09:26rounded edges and its placement is kind of midline belly button to pubic area which is what we would like to see so now I'm going to move up to palpating your other organs this is a little bit of a deeper palpation
1:10:06so all of that was normal and I do just want to note okay so are
1:10:29midline to pelvic region no notable differences with your pelvic bone everything appeared to be in place percussions of your rage War also noted to be
1:10:52normal okay all right while you're doing great so we are going to move on to the next portion of your abdominal assessment and do just want to take a couple of very brief measurements for symmetry here so essentially we're just measuring to see that the distance from certain points on
1:11:12one side are normal in comparison to the other side okay so since I have your shirt pulled up pretty equally from one side to the other I'm going to use this as kind of a base Point here so measuring here okay comparing that to the other
1:11:39side good and then I'm going to measure the widest point which you can see is slightly just very slightly longer so about 8 and 1 half in there also going to measure the
1:11:59distance from your belly button to your bladder as well as just the length and width of the belly button itself okay now noting the rise of your abdomen here I'm going to go ahead and measure from the
1:12:19shallowest point good as well as the width the widest point here perfect okay
1:12:45good okay so in keeping with the measurements I'm going to move on to using a different device and these are called purse and essentially I'm going to use this to perform the same thing I'm just measuring one side to the other these are very cold I do apologize it is a very cold metal so might be just a
1:13:07little bit startling here so I'm going to start midline to the edge of your rib cage here
1:13:27and then compare that to the other side to perform that as well in the lower quadrant as well on this side I did notice a very slight difference here
1:13:53so SL offset from the center on this side but it's not any more than about a half an inch which is okay so again measuring the distance here
1:14:25good okay perfect so what I'm going to do now is just going to take this tongue depressor and essentially it's just a
1:14:46wooden stick that I'll be using to once again assess the texture of your skin as a whole so what I'm going to do is just use this as a a kind of a tool to help me pull the skin push slightly taut here so that I can have a look at the overall texture of the skin assessing for any
1:15:08abnormalities in skin texture so because the wood is so smooth it will catch on any areas that are not as smooth so it really just allows me to know anything that I might have missed with my eye
1:15:39okay
1:16:23of course just check to make sure that the is in fact not
1:16:49raised so while I have this tool out I am going to be using it length to measure the depth of your umbilicus or your belly button and the purpose of this examination is to measure how far your belly butt KNE ually goes and note any possible abnormalities there so there is an
1:17:11average length that we like to see in adult females and that's what I'll be testing okay so just going to literally insert this into your belly button and just going to
1:17:31note just want to make sure I get an accurate reading here so just noting depth here I will go ahead
1:17:57and measure that and you are about 3/4 of an inch great so I will go ahead and quickly notate that
1:18:33perfect okay we are going to go ahead and move on to your abdominal assessment so give me just a second while I get that set up and we will get started okay okay all right Isabelle so now that we have you all settled and ready for your abdominal assessment we will go ahead and get started so is it okay if I go
1:18:51ahead and pull back your sheet okay so just going to pull this back just enough to expose your abdominal cavity here and just be folding this over a little
1:19:12bit so similar to the examination of your face we're performing a visual assessment and then we'll get started with the physical portion of your exam real quick just fing the sa okay so also going to be exposing
1:19:35your belly so I'll just pull your shirt up a little bit if that's all right with you and you're welcome to just relax your arms in whatever way is comfortable do you want to place this arm at your side that's fine perfect and we just go ahead and fold this over here so that just your
1:19:56abdominal cavity is exposed and very slightly pulling down your paint in an effort to expose the umbilicus here so we can go ahead and get started with your assessment and perfect okay okay so let's begin by performing a
1:20:20bit of a visual assessment so just going to a look at the overall Integrity of your skin so looking for any kinds of abnormality and skin texture and his signs of aemma which would be like a pinkish red rash sometimes blotchy but usually
1:20:42isolated so not seeing any SIDS of that here and skin appears clear no signs of excess stretching of the skin or anything abnormal there also having a very brief look at the umbilicus to start looking for any
1:21:03signs of abnormality here in either shape or depth which we will be measuring shortly does appear that you have a piercing and doesn't appear that this piercing is active so you must have had it closed for some time okay so I'm going to start by
1:21:23having a look with my pen light so just beginning with a visual assessment having a look with my pen light looking for any more obvious signs of abnormality that weren't noticeable to the neck and ey so having a
1:21:44look and notating any possible abnormalities not seeing so far the skin does appear very clear in texture normal color variation
1:22:09throughout okay so just having a bit of a closer look at the umbilicus here and noting any sides of abnormality in the piercing mainly any Scar Tissue so what I'm going to do is shine my light from one end of the piercing to the other and I am seeing actually a fair
1:22:30amount of Light That Could indicate that your piercing is actually active know you said that it had been a while since you actually put a piercing in it so I would be cautious before putting anything in there just to make sure that it is open but it doesn't appear that it has fully closed so just something to
1:22:53note okay so let's go ahead and move on and going to be performing a couple palpations so just like we did on the crani I'm just using my hands to gently palpate around the abdomen here okay so you let me know if this causes you any pain I'm going to start by palpating
1:23:13around your rib cage and first just doing a very gentle depth not going in too far just measuring around the ribs looking for any sense of abnormality
1:23:35here good as well on the other side of course looking comparatively from one side to the other notating any differences in depth or anything that could indicate an abnormality in your rib health so that does appear to be
1:23:55normal also going to just take a second to observe your breathing pattern so looking at your breathing upon inhale and exhale looking for any differences in depth from one side to the other
1:24:16anything that can indicate an abnormality in your lung Health that does not appear to be present so that's a good sign so now just palpating along the mid abdominal wall these are your obliques very gently palpating down towards the
1:24:36umbilicus feeling for any signs of hernia so with straight or excess pressure sometimes weight lifting or improper body mechanics we can see hernas that tend to appear in this area towards the belly button and I'm just
1:24:58palpating around to feel for any signs of abnormality there so do apologize if this is uncomfortable so I'm going to do a little bit of a deeper palpation and this time I'm feeling around for your organs just feeling for any signs of
1:25:19inflammation in the organs also feeling your intes feeling for any signs of constipation or inactive [Music] bowels and all of that does appear to be normal perfect okay so what I'm going to do Isabelle is
1:25:41go in with my stethoscope and I'm just going to be having a listen to your abdomen and this is just going to allow me to listen for any signs of normality that are not audible to my ear so I do apologize this instrument is very very
1:26:01cold so I'm just going to be placing this on your abdomen in various quadrants and I'd like you to just relax and take some normal breaths for me okay
1:26:30very good you're doing so well just listening
1:26:52thoroughly making sure I'm not not missing anything and no osculating right above your intestinal [Music] wall listening to your bow and I am hearing active bow zones does also appear as if you've not eaten in the last few hours your stomach is growling
1:27:15which is perfectly normal just going to listen directly above the umbilicus
1:27:36perfect okay all of that sounds completely healthy so that is a very good sign of good gut health so me just a second while I place my stethoscope back in the holder okay so I'm going to move on to a couple
1:27:57of measurements of your abdomen and essentially just measuring for symmetry so I apologize this tool is very cold this is just a measuring device that will allow me to assess for symmetry just adjusting slightly
1:28:22here perfect so I'm just going to start by measuring the basic width of your rib cage so starting here and following down
1:28:54so move on to measuring vertically and again just measuring for Symmetry and I don't expect this to be perfectly symmetrical but I would like to see a base of
1:29:15symmetry and [Music] so our belly button do here symmetrical essentially just looking for symmetry among all sides and an even
1:29:37diameter perfect okay so of course at this point I am just going to perform a couple basic percussions of your abdominal wall so you just relax it's the same Hammer that I used for your head exam and just
1:29:58to start I'm going to be prussing along your rib cage good
1:30:18perfect moving on to the lower quadrant
1:30:40directly over the umbilicus Sy the obious ab normalities here which are not notating so
1:31:20so all of that does appear to be intact what I'm going to do at this time is test your abdominal reflex and I'm going to test this by placing different textures temperatures variations on your stomach and you don't
1:31:40really have to do anything I'm just looking for a very specific reaction in the muscles of your abdomen okay so just started like you did just relax for me keep your eyes closed and you're going to feel an object on your skin very good so just looking for that
1:32:03natural flexing of the abdominal muscles very good very healthy reaction there [Music] again very good good job
1:32:26okay going to repeat that test with a different object just keep your eyes close for me
1:32:48good perfect good job perfect great job you've doing so well I'm going to move on by performing a series
1:33:09of that same sharper do test this time using different tools and you just relax for me and again indicate whether or not you feel sharp or do this time I will be providing you with an example because the variations are less distinct so this is going to be our
1:33:36dull and this is going to be our sharp okay so you just indicate to me what you feel Shar
1:34:02very goodar good Shar don't very good and sharper doll
1:34:25good you're doing great sharper [Music] doll perfect and sharper doll you're doing very well sharper doll perfect sharp very good sharp very
1:34:48good Shar perfect good job and Shar Shar
1:35:08gooder good very good sure very good that was perfect so I'm going
1:35:31to switch to a different object here and this time you're going to feel dull or soft and I'd like you to indicate to me whether or not you feel the soft or the dll
1:35:56[Music] so perfect and good soft very
1:36:19good good job soft perfect soft good job D very
1:36:41good d soft So Soft very good
1:37:02and sof perfect good job Isabelle you are doing very well okay so I believe that concludes our abdominal assessment with the
1:37:22exception of the measurement of your belly button so what I'm going to do at this time is very gently place this object into the depth of your belly button and then I'll be using my pen light to just measure and we're just getting a baseline measurement here looking for any signs of abnormals or abnormal depth that can indicate an
1:37:44injury to the base of your belly button centrally okay so just relax for me this test is a little bit ticklish and am just going to go ahead and insert into the depth of your belly button here very
1:38:07gently and when I hit resistance I am going to lower my fingers down and remove and then just using the measurement on my penl to indicate how deep we are so getting a measurement about one
1:38:29and a half in and just as good measure I'm going to do that one more time so just relax for me just very gently meing resistance and again about 1 and 1 half in so it's
1:38:50a good indication that there is a healthy depth so nothing to worry about there so that does conclude our abdominal assessment [Music]