Abdomen - Lab Portion Flashcards
Abdominal exam is done in the following order:
- Inspection
- Ausculation
- Percussion
- Palpation
Very important for OSCE!
The patient should be in what anatomical position when doing an abdominal exam?
Supine
The two main points to make sure you do when inspecting are (two things):
- Verbalize findings
- Drape properly (life up shirt to bra line/rib area and tuck drape into pants)
What is the proper way to verbalize your findings on the inspection portion of the exam?
“I see no scars, masses, discoloration, bruising, ascites”
You could potentially see positive Cullen’s sign/Grey-Turner’s sign or Linea Nigra
For auscultation portion of the exam, you listen to all 4 quadrants with what portion of the stethoscope?
The Diaphragm
For aortic bruits, you would use what portion of the stethoscope and where would these typically be found?
- The bell
- Left Upper Quadrant
For the percussion portion of the abdominal exam, you don’t want to hear a large area of dullness unless you are percussing over what two structures?
- Liver
- Spleen
See organ placement diagram
When percussing, what tells you that there is no sign of spleenomegaly?
You will hear tympany
You will go to anterior axillary line along last intercostal space - make sure they hold their breath in between
When you are palpating, you are doing so to elicit what?
PAIN
Make sure to do all four quadrants and do light + deep palpation
If the right upper quadrant is painful to palpation, that could be due to…(try to name 2-3 of them)
- Liver pain
- hepatitis
- gallbladder pain
- part of pancreas
- transverse colon spans both RUQ and LUQ
If the left upper quadrant is painful to palpation, that could be due to…(try to name 2-3 of them)
- Stomach
- Spleen
- Rest of pancreas
- transverse colon spans both RUQ and LUQ
What organ is in both lower quadrants?
Small Intestine
What part of the colon is in the RLQ?
Ascending Colon
What part(s) of the colon is in the LLQ?
- Descending Colon
- Sigmoid Colon
If the patient describes burning in the upper quadrants, you will want to think what?
Ulcers (duodenal in RUQ or gastric in LUQ)
If the patient describes cramping, think ________. This is when…(describe what is occuring)
- Biliary Colic
- A gallstone is blocking a bile duct which creates a lot of pain for the patient
If the patient describes a tearing or ripping feeling, this could be a…
Aortic Dissection - VERY BAD –> GO TO ER
When you find a tender area of the abdomen, you will utilize the test for what we call ________, and make sure to ask them if it hurts more when you ________ in or when you ________ away
- Rebound Tenderness
- Push
- Pull
Mcburney’s Point/sign is an indication of…
Appendicitis
amongst other things
Rovsing’s Sign (while outdated) is when you palpate the LLQ, but the pain shows up in the…and is used for an indication of what?
- RLQ
- Appendicitis
A Murphy’s Sign is when you ask the patient to inhale while you palpate the ________ quadrant, and if they experience pain or stop inhaling, that is an indication of/concerning for….
- RUQ
- Gallstones - results in Cholecystitis
inflammation of gallbladder
usually done with liver palpation
Iliopsoas/Obturator test is used to test for…
peritoneal inflammation
not a great test because people’s lack of flexibility takes away from the specificity of the test - Iliopsoas test = bring straight leg up and have patient push against resistance and Obturator test = bent knee to 90 and internally + externally rotate the knee
The heel jar test is performed to test for…
Peritoneal inflammation
A question to ask and put in history is - “did the car drive over bring about any pain such as going over bumps on the road?”
Lloyd’s Test is performed to test for…and the patient is in what position?
- Kidney Stones
- Seated upright
Fluid wave test is performed to test for….
Ascites - AKA fluid back up in the abdomen
