Abdomen Flashcards
Name the left sided regions of the abdomen in descending order.
- Left hypochondriac region.
- Left lumbar region.
- Left inguinal region.
Name the right sided regions of the abdomen in descending order.
- Right hypochondriac region.
- Right lumbar region.
- Right inguinal region.
Name the middle abdomen regions in descending order.
- Epigastric region.
- Umbilical region.
- Hypogastric region.
Describe tympany related to abdominal percussion.
Tympany is a high-pitched musical sound that is heard over air filled regions of the abdomen. This should be the predominant sound heard during percussion in the abdomen.
Describe dullness related to abdominal percussion.
Dullness is a high-pitched, short sound that is heard over underlying organs. The liver and spleen are the primary organs that produce a dullness when percussed.
Resonance
Resonance is a medium pitched, sustained sound heard over the lung areas primarily.
Describe how the liver is percussed.
The liver is located on the right side of the abdomen in the RUQ. Percussion can identify the upper and lower borders of the liver to determine if the liver is enlarged.
Begin in an area of tympany or resonance and work toward where the liver should be to easily distinguish the difference in sound. Work up and down the midclavicular line, marking the lower and upper borders where percussion sounds turn to dullness. Measure this distance. A normal liver span is between 6-12 cm.
How is the liver palpated during exam.
The liver is located in the RUQ. In most healthy adults, the liver is nonpalpable. A palpable healthy liver would be felt as smooth and firm and non-tender.
Place left hand under the patient’s flank using it to apply upward pressure. Use the right hand to apply downward and slightly upward pressure in the RUQ with the finger tips pressing just below the costal margin. Have the patient take a deep breath in.
How is the gallbladder palpated during abdominal exam?
The gallbladder is located in the RUQ lateral to the rectus abdominis and medial to the liver. A normal, healthy gallbladder is non-palpable. If pain, tenderness, or termination of the deep breath are seen upon deep palpation of this area then cholecystitis is possible. This is considered a positive Murphy’s sign.
How is the spleen percussed during physical exam of the abdomen?
The spleen is located in the LUQ lateral to the midaxillary line. A normal spleen is not percussable in a healthy individual. Following this line, percuss up and down noting when percussion characteristics turn into dullness.
How is the spleen palpated during physical exam?
The spleen is palpated in a similar way as the liver, just on the opposite side. Place a hand under the patient’s flank, using it to apply upward pressure. Place the other hand over the patient’s abdomen and use downward pressure with finger tips in the costal margin to palpate. Have the patient take a deep breath.
Gastric bubble percussion
Percuss in the area of the left 5th ICS space midclavicular line. Work downwards listening for the change from resonance (over the lungs) to tympany (over the stomach, gastric bubble).
How are the kidney’s percussed?
The kidney’s are percussed in a similar manner as the liver and the spleen. One hand is placed under the patient’s flank and is used to push upwards while the other hand is placed at the lower costal margin applying downward pressure. Have the patient take a deep breath. The kidneys are ordinarily not palpable in healthy individuals.
How are the kidney’s percussed?
The kidney are percussed via indirect percussion near the costovertebral angle. Indirect percussion is done by placing one hand flat over the angle while using the other hand, in a fist, to strike the overlying hand. This should produce a thud, but should not result in pain or tenderness. The costovertebral angle is found where the ribs meet the vertebrae in the center, upper back.
How is the aorta palpated during the abdominal exam?
The aorta is palpated using deep palpation slightly to the left of the sternal line.
How is the urinary bladder palpated?
Normally, in a healthy individual, the bladder would not be able to be palpated. If the patient’s bladder is full, it should feel round, smooth, and somewhat tense.
In what order are the abdominal assessments completed? Why?
- Inspection
- Auscultation
- Percussion
- Palpation
- Deep palpation
Normally the assessment goes:
- Inspection
- Palpation
- Percussion
- Auscultation
The order is altered because manipulation of the stomach can alter bowel habits.
How does the abdomen assessment differ in pregnant patients?
- Uterus - the uterus enlarges during pregnancy as the fetus grows. This enlargement displaces surrounding structures. Uterine size should be measured at each check-up.
- Abdominal stretch - the growing uterus and fetus stretch the abdominal wall and muscles. This can result in diastasis recti (separation of the rectus abdominis). Can also result in striae.
- Constipation is more prevalent.
- Gallstones are more common.
- Bladder compression.
Describe the advanced technique fluid wave
Fluid wave is done to assess for possible excess fluid in the abdominal cavity. Excess fluid here is seen with ascites. The patient is placed in a supine position. They are asked to use one hand and forearm to apply firm pressure down the center of the abdomen. This assistance is used as a dampening. The provider then places a hand on one side the abdomen which is used to feel for the shift of fluid. The other hand is used to create the fluid wave by firmly striking the opposite side of the patient’s abdomen.
Describe the advanced technique shifting dullness
Shifting dullness is also used to assess for excess fluid seen in patient’s with possible ascites. Percussion is used to determine where tympany stops and dullness starts in the lateral portions of the abdomen. These lines of differentiation are marked. The patient is then asked to roll on one side. The percussion exam is resumed. The areas of tympany and dullness would have changed due to gravity in a patient with ascites.
Rebound tenderness
This exam is done to assess for possible peritonitis or appendicitis. The patient is placed in the supine position. The provider uses their hand, at a 90 degree angle, to apply firm pressure near the area of pain. The pressure is quickly released. Presence of pain upon release of pressure is a positive rebound tenderness sign. Bloomberg sign is generalized rebound tenderness indicating possible peritonitis. Pain at McBurney’s point, an area in the RLQ indicates possible appendicitis.
Iliopsoas muscle test
A muscle test that is used to help diagnose appendicitis. The right lateral iliopsoas muscle is in close proximity to the appendix. When the appendix is inflamed, this inflammation can push on this muscle causing pain upon exam. Exam is done by having the patient lay in supine position and attempt to elevate their leg in opposition to practitioner pushing down slightly.
Obturator muscle test
A muscle test that is used to help diagnosis appendicitis. This muscle lies in close proximity to the appendix. Exam is done by having the patient lie in supine position, flexing their knee, placing one hand under the ankle and the other under the knee, laterally and then medially rotate the right leg. If this causes pain or discomfort it is a positive test and could indicate appendicitis.
What are the risk factors for PUD?
Peptic ulcer disease is most commonly associated with H. pylori infection resulting in increased gastrin and stomach acid secretion. The H. pylori bacteria burrow into the less acidic parts of the abdomen but leave a trail that allows gastric secretions to irritate the lining of the stomach resulting in ulcer formation.
Chronic use of NSAIDs and ASA are common contributing factors.
Males are twice as often affected.
Results in upper GI bleeding which can present as hematemesis or melena.
