Abdomen Objective

Question 1

Inspecting the contour of the abdomen

Answer 1

• Stand on persons right side and look down the abdomen. Determine profile from the rib margin to the pubic bone. COntour describes nutritional state and ranges from flat-round.
• flat, scaphiod (caves in, below level of hip bone), rounded, protuberant.

Question 2

Inspect symmetry of abdomen

Answer 2

Shine light across abdomen toward you or lengthwise across person. Have them take a deep breath to further highlight changes. May also ask them to do a sit-up without using their hands (this may show hernia or enlarged liver or spleen).
Normal= “abdomen is symmetrical, smooth, bilaterally)
Abnormal=Note any bulging, masses, or asymmetrical shape. Hernias are protrusion of the abdominal viscera through an opening in muscle wall.

Question 3

Inspect umbilicus

Answer 3

Normal= “umbilicus is midline and inverted with no discoloration, inflammation, or hernia. If pregnant, it everts.
Abnormal:
-Everted=ascites or underlying mass.
- Deeply sunken= obesity
- enlarged, everted= umbilical hernia
-bluish periumbilical color with intra-abdominal bleeding (Cullen sign)

Question 4

inspect skin of abdomen- Normal Findings

Answer 4

Normal= “skin is smooth and even, with homogenous color”
*good area to judge pigment of skin since it is covered from sun.
-Striae: Common pigment change that is silvery white, linear, jagged marks about 1-6 cm long. Occur when elastic fibers in the reticular layer of skin and broken after rapid, prolonged stretching (pregnancy, excessive weight gain). They start out as pink or blue and turn silverish.
*purple/blue straie are abnormal- cushings
- Pigmented nevi may be present
-scars may be present
-Veins are usually not seen.
Good skin turgor reflects healthy nutrition (check turgor)

Question 5

What do you do when inspecting skin and a scar is present ?

Answer 5

Draw its location in the persons record, and indicate the length in cm. Ask about the scar and if it is from surgery. A surgical scar alerts you to possible presence of underlying adhesions and excess fibrous tissue.

Question 6

Abnormalities inspecting skin color

Answer 6

Color Abnormalities:

• Redness with localized inflammation
• Jaundice (best in natural light)
• Skin that is glistening and taut is sign of ascites

Question 7

Abnormalities inspecting skin of abdomen–abnormal striae

Answer 7

• striae occurs with ascites

- purple/blue striae with Cushings (excess ACTH)

Question 8

Inspecting skin of abdormen- abnormal lesions

Answer 8

• any unusual change in color or shape
• Petechiae
• Cutaneous anginomas (spider nevi) occur with portal hypertension or liver disease
• lesions or rashes
• underlying adhesions are inflammatory bands that connect opposite sides of serous surfaces after trauma or surgery

Question 9

Inspecting skin of abdomen- Abnormal veins

Answer 9

Prominent, dilated veins occur with portal hypertension, cirrhosis, ascites, or vena caval obstruction. Veins are more visible with malnutrition as a result of thinned adipose tissue.

Question 10

inspecting skin of abdomen- abnormal turgor

Answer 10

poor turgor occurs with dehydration, which often accompanies GI disease

Question 11

Inspecting abdomen pulsation and movement- Normal

Answer 11

Normally see pulsation of aorta beneath skin in the epigastric area, particularly in those with good muscle wall relaxation.

• normally see respirations especially in males
• normally see waves of peristalsis in very thin people

Question 12

Inspecting pulsation and movement- abnormal findings

Answer 12

• Marked pulsations of aorta occurs with widened pulse pressure ( hypertension, aortic insufficiency, thyrotoxicosis), and aortic aneurysm
• marked visible peristalsis together with distended abdomen indicated intestinal obstruction

Question 13

abnormal/altered hair distribution occurs with?

Answer 13

endocrine or hormone abnormalities, and chronic liver disease

Question 14

Normal Demeanor

Answer 14

relaxed, quietly on table and has benign facial expression and slow even respirations

Question 15

Abnormal demeanor

Answer 15

• restlessness and constant turning to find comfort- colickly pain of gastroenteritis or bowel obstruction
• Absolute stillness, resisting any movement occurs with pain of peritonitis
• knees flexed up, facial grimicaing, and rapid, uneven respirations also indicate paine

Question 16

Procedure for auscultating bowel sounds

Answer 16

• Auscultation after inspection and before paplation or percussion.
• use diaphragm and hold lightly against skin
• begin in RLQ at ileocecal valve because bowel sounds are normally always present there

Question 17

Normal findings when auscultating bowel sounds

Answer 17

• Note the character and frequency of bowel sounds
• bowel sounds are high pitched, gurgling, cascading sounds, occuring irregularly anywhere from 5-30 per min. Dont count them. Just note if they are normal, hypoactive or hyperactive.
• Normal hyperactive bowl sound is borborgymus (stomach growling)

Question 18

Completely absent bowel sounds

Answer 18

uncommon. must listen for 5 min before deciding bowel sounds are completely absent.

Question 19

Abnormal Bowel Sounds (hyperactive & hypoactive)

Answer 19

• Hyperactive: loud, high pitch, rushing, tinkling sounds that signal increase motility
• Hypoactive or absent: follow abdominal surgery or with inflammation or peritoneum

Question 20

Auscultating Vascular sounds- Normal findings

Answer 20

• Listen for bruits using firmer pressure
• check over aorta, renal arteries, iliac, femoral arteries (ESPECIALLY in people with hypertension!)
• Bruits should not be present UNLESS it is a healthy person who is younger than 40 yrs, and the sound originates from celiac artery. (sound is systolic, medium to low pitch, and heard between xiphoid process and umbilicus_

Question 21

Auscultating vascular sounds- abnormal findings

Answer 21

If vascular sound is found, note the location, pitch and timing.

• systolic bruit is a pulsatile blowing sound and occurs with stenosis or occlusion of artery
• venous hum and peritoneal friction rub are rare

Question 22

Percussing for tympany in all 4 Q- Abnormal findings

Answer 22

• Dullness occurs over distended bladder, adipose tissue, fluid, or mass.
• Hyperresonance with gaseous distention

Question 23

Percussing liver span

Answer 23

Measure the height of the liver in the right midclavicular line.

• the liver span usually is underestimated because of inaccurate detection of the upper border.
• Begin in the area of lung resonance, and percuss down the interspaces until the sound changes to a dull quality Mark the spot, usually in the fifth intercostal space. Then find abdominal tympany and percuss up in the midclavicular line. Mark where sound changes from tympany to a dull sound, normally at the right costal margin.
• Measure the distance between the two marks; the normal liver span in the adult ranges from 6 to 12cm
• height of the liver span correlates with the height of the person; taller people have longer livers. - males have a larger liver span than females of the same height.
• mean liver span is 10.5cm for males and 7cm for females.

Question 24

Percussing liver span- abnormal findings

Answer 24

-An enlarged liver span indicates liver enlargement or hepatomegaly.

• Accurate detection of liver borders is confused by dullness above the fifth intercostal space, which occurs with lung disease (e.g., pleural effusion or consolidation).
• Accurate detection at the lower border is confused when dullness is pushed up with ascites or pregnancy or with gas distention in the colon, which obscures the lower border.

Question 25

Liver span in emphysema patients

Answer 25

One variation occurs in people with chronic emphysema, in which the liver is displaced downward by the hyperinflated lungs. Although you hear a dull percussion note well below the right costal margin, the overall span is still within normal limits.

Question 26

The Scratch Test for liver border

Answer 26

Although traditionally taught, this technique does not work to identify the liver border. It uses a repeated scratching sound from your fingernail along the patient’s abdomen; when the sound is magnified in the stethoscope, it was thought to define the lower liver border. However, evidence shows no correlation whatsoever between the liver edge by auscultation of scratches and the actual liver edge by ultrasound

Question 27

Percussing for Spenic Dullness

Answer 27

Often the spleen is obscured by stomach contents, but you may locate it by percussing for a dull note from the ninth to eleventh intercostal space just behind the left midaxillary line

• The area of splenic dullness normally is not wider than 7cm in the adult and should not encroach on the normal tympany over the gastric air bubble.
• Next, percuss in the lowest interspace in the left anterior axillary line. Should hear tympany Ask the person to take a deep breath. Normally, tympany remains through full inspiration.

Question 28

Abnormal Splenic dullness

Answer 28

• A dull note forward of the midaxillary line indicates enlargement of the spleen, as occurs with mononucleosis, trauma, and infection.
• When percussing anterior axillary line, a change in percussion from tympany to a dull sound with full inspiration is a POSITIVE SPLEEN PERCUSSION SIGN, indicating splenomegaly. This method will detect mild to moderate splenomegaly before the spleen becomes palpable, as in mononucleosis, malaria, or hepatic cirrhosis.

Question 29

Percuss for Costovertebral Angle Tenderness

Answer 29

ndirect fist percussion causes the tissues to vibrate instead of producing a sound. To assess the kidney, place one hand over the twelfth rib at the costovertebral angle on the back (Fig. 21-17). Thump that hand with the ulnar edge of your other fist. The person normally feels a thud but no pain. (Although this step is explained here with percussion techniques, its usual sequence in a complete examination is with thoracic assessment, when the person is sitting up and you are standing behind.)
*ABNORMAL FINDING= Sharp pain occurs with inflammation of the kidney or paranephric area.

Question 30

How do you determine is person has Ascites?

Answer 30

• distended abdomen, bulging flanks, umbilicus that is protruding and displaced downward. Do these test to differentiate ascites from gaseous distention:
• Fluid wave test
• Shifting Dullness test

Question 31

Fluid Wave test

Answer 31

• Stand on the person’s right side. Place the ulnar edge of hand or the patient’s own hand firmly on the abdomen in the midline (This will stop transmission across the skin of the upcoming tap.) - Place your left hand on the person’s right flank. With your right hand, reach across the abdomen and give the left flank a firm strike.
• If ascites is present, fluid wave through the abdomen and you will feel a distinct tap on your left hand. If the abdomen is distended from gas or adipose tissue, you will feel no change.
• Positive fluid wave test occurs with large amounts of ascitic fluid.

Question 32

Shifting dullness

Answer 32

• In a supine person, ascitic fluid settles by gravity into the flanks, displacing the air-filled bowel upward. You will hear a tympanitic note as you percuss over the top of the abdomen because gas-filled intestines float over the fluid). Then percuss down the side of the abdomen.
• If fluid is present, the note will change from tympany to dull as you reach its level. Mark this spot.
• Now turn the person onto the right side (roll the person toward you). The fluid will gravitate to the dependent (in this case, right) side, displacing the lighter bowel upward. Begin percussing the upper side of the abdomen and move downward. The sound changes from tympany to a dull sound as you reach the fluid level, but this time the level of dullness is higher, upward toward the umbilicus. - - This shifting level of dullness indicates the presence of fluid.
• Shifting dullness is positive with a large volume of ascitic fluid: it will not detect less than 500mL of fluid.

Question 33

Procedure for palpating

Answer 33

1 Bend the person’s knees.
2 Keep your palpating hand low and parallel to the abdomen. Holding the hand high and pointing down would make anyone tense up.
3 Teach the person to breathe slowly (in through the nose, and out through the mouth).
4 Keep your own voice low and soothing. Conversation may relax the person.
5 Try “emotive imagery.” For example, you might say, “Now I want you to imagine you are dozing on the beach, with the sun warming your muscles and the sound of the waves lulling you to sleep. Let yourself relax.”
6 With a very ticklish person, keep the person’s hand under your own with your fingers curled over his or her fingers. Move both hands around as you palpate; people are not ticklish to themselves.
7 Alternatively, perform palpation just after auscultation. Keep the stethoscope in place and curl your fingers around it, palpating as you pretend to auscultate. People do not perceive a stethoscope as a ticklish object. You can slide the stethoscope out when the person is used to being touched.

Question 34

Light Palpation

Answer 34

With the first four fingers. depress the skin about 1cm. Then lift the fingers (do not drag them) and move clockwise to the next location around the abdomen.
- Do not search for organs but form an overall impression of the skin surface and superficial musculature. Save the examination of any identified tender areas until last. This method avoids pain and the resulting muscle rigidity that would obscure deep palpation later in the examination.

Question 35

Voluntary gaurding during light palpation

Answer 35

As you circle the abdomen, discriminate between voluntary muscle guarding and involuntary rigidity. Voluntary guarding occurs when the person is cold, tense, or ticklish. It is bilateral, and you will feel the muscles relax slightly during exhalation. Use the relaxation measures to try to eliminate this type of guarding, or it will interfere with deep palpation. If the rigidity persists, it is probably involuntary.

Question 36

Abnormalities during light palpation

Answer 36

Muscle guarding.
Rigidity.
Large masses.
Tenderness

Question 37

Involuntary rigidity during light palpation

Answer 37

Involuntary rigidity is a constant, boardlike hardness of the muscles. It is a protective mechanism accompanying acute inflammation of the peritoneum. It may be unilateral, and the same area usually becomes painful when the person increases intra-abdominal pressure by attempting a sit-up.

Question 38

Deep Palpation

Answer 38

push down about 5 to 8cm (2 to 3 inches) (Fig. 21-22). Moving clockwise, explore the entire abdomen.

• To overcome the resistance of a very large or obese abdomen, use a bimanual technique.
• Note the location, size, consistency, and mobility of any palpable organs and the presence of any abnormal enlargement, tenderness, or masses.

Question 39

Normally Palpable structures

Answer 39

• Xiphiod Process
• Normal liver edge
• Right kidney, lower pole
• Pulsatile aorta
• rectus muscles, lateral borders
• Sacral promontory
• ascending colon
• cecum
• sigmoid colon
• uterus
• full bladder

Question 40

Sigmoid colon

Answer 40

Normally, mild tenderness during palpation. Investigate any other tenderness.

Question 41

Tenderness during palpation occurs with ?

Answer 41

Tenderness occurs with local inflammation, with inflammation of the peritoneum or underlying organ, and with an enlarged organ whose capsule is stretched.

Question 42

If you identify a mass, first distinguish it from a normally palpable structure or an enlarged organ. Then note the following:

Answer 42

1 Location
2 Size
3 Shape
4 Consistency (soft, firm, hard)
5 Surface (smooth, nodular)
6 Mobility (including movement with respirations)
7 Pulsatility
8 Tenderness

Question 43

Normal palpation of liver

Answer 43

RUQ (Fig. 21-25). Place your left hand under the person’s back parallel to the eleventh and twelfth ribs and lift up to support the abdominal contents. Place your right hand on the RUQ, with fingers parallel to the midline. Push deeply down and under the right costal margin. Ask the person to breathe slowly. With every exhalation, move your palpating hand up 1 or 2cm. It is normal to feel the edge of the liver bump your fingertips as the diaphragm pushes it down during inhalation. It feels like a firm, regular ridge. Often, the liver is not palpable and you feel nothing firm.

Question 44

Abnormal Palpation of liver

Answer 44

Except with a depressed diaphragm, a liver palpated more than 1 to 2cm below the right costal margin is enlarged. Record the number of centimeters it descends and note its consistency (hard, nodular) and tenderness

Question 45

Is the spleen normally palpable?

Answer 45

Normally, the spleen is not palpable and must be enlarged three times its normal size to be felt. To search for it, reach your left hand over the abdomen and behind the left side at the eleventh and twelfth ribs (Fig. 21-27, A). Lift up for support. Place your right hand obliquely on the LUQ with the fingers pointing toward the left axilla and just inferior to the rib margin. Push your hand deeply down and under the left costal margin and ask the person to take a deep breath. You should feel nothing firm.

Question 46

If the spleen is palpable, what could it mean?

Answer 46

The spleen enlarges with mononucleosis, trauma, leukemias, and lymphomas (see Table 21-6). If you feel an enlarged spleen, refer the person but do not continue to palpate it. An enlarged spleen is friable and can rupture easily with overpalpation.
Describe the number of centimeters it extends below the left costal margin.
- When enlarged, the spleen slides out and bumps your fingertips. It can grow so large that it extends into the lower quadrants. When this condition is suspected, start low so you will not miss it. An alternative position is to roll the person onto his or her right side to displace the spleen more forward and downward. Then palpate.

Question 47

Palpating for Kidneys

Answer 47

Search for the right kidney using “duck-bill” position at the person’s right flank. Press your two hands together firmly (you need deeper palpation than that used with the liver or spleen) and ask the person to take a deep breath. In most people, you will feel no change. Occasionally, you may feel the lower pole of the right kidney as a round, smooth mass slide between your fingers. Either condition is normal.
The left kidney sits 1cm higher than the right kidney and is not palpable normally. Search for it by reaching your left hand across the abdomen and behind the left flank for support. Push your right hand deep into the abdomen and ask the person to breathe deeply. You should feel no change with the inhalation.

Question 48

Palpating for Aorta

Answer 48

Using your opposing thumb and fingers, palpate the aortic pulsation in the upper abdomen slightly to the left of midline (Fig. 21-29). Normally, it is 2.5 to 4cm wide in the adult and pulsates in an anterior direction.
*Abnormal Aorta= Widened with aneurysm.
Prominent lateral pulsation with aortic aneurysm pushes the examiner’s two fingers apart.

Question 49

Rebound Tenderness (Blumberg Sign)

Answer 49

Assess rebound tenderness when the person reports abdominal pain or when you elicit tenderness during palpation. Choose a site away from the painful area. Hold your hand 90 degrees, or perpendicular, to the abdomen. Push down slowly and deeply, then lift up quickly.
This makes structures that are indented by palpation rebound suddenly. A normal, or negative, response is no pain on release of pressure. Perform this test at the end of the examination, because it can cause severe pain and muscle rigidity.

Question 50

Abnormal finding of rebound tenderness/blumberg sign

Answer 50

Pain on release of pressure confirms rebound tenderness, which is a reliable sign of peritoneal inflammation. Peritoneal inflammation accompanies appendicitis.

Cough tenderness that is localized to a specific spot also signals peritoneal irritation. Refer the person with suspected appendicitis for computed tomography (CT) scanning.

Question 51

Inspiratory Arrest (Murphy Sign)

Answer 51

Normally, palpating the liver causes no pain. In a person with inflammation of the gallbladder (cholecystitis), pain occurs. Hold your fingers under the liver border. Ask the person to take a deep breath. A normal response is to complete the deep breath without pain. (Note: This sign is less accurate in patients older than 60 years; evidence shows that 25% of them do not have any abdominal tenderness)

Question 52

Positive/abnormal murphy sign

Answer 52

When the test is positive, as the descending liver pushes the inflamed gallbladder onto the examining hand, the person feels sharp pain and abruptly stops inspiration midway.

Question 53

Iliopsoas Muscle Test

Answer 53

Perform the iliopsoas muscle test when the acute abdominal pain of appendicitis is suspected. With the person supine, lift the right leg straight up, flexing at the hip, then push down over the lower part of the right thigh as the person tries to hold the leg up. When the test is negative, the person feels no change. (Note: Evidence shows that the Obturator Test, another technique that stretches the obturator muscle, does not work to diagnose appendicitis)

Question 54

Abnormal lliopsoas muscle test

Answer 54

When the iliopsoas muscle is inflamed (which occurs with an inflamed or perforated appendix), pain is felt in the right lower quadrant.

Question 55

Normal findings in the aging adult

Answer 55

On inspection, you may note increased deposits of subcutaneous fat on the abdomen and hips because it is redistributed away from the extremities. The abdominal musculature is thinner and has less tone than that of the younger adult; thus, in the absence of obesity, you may note peristalsis.

Because of the thinner, softer abdominal wall, the organs may be easier to palpate (in the absence of obesity). The liver is easier to palpate. Normally, you will feel the liver edge at or just below the costal margin. With distended lungs and a depressed diaphragm, the liver is palpated lower, descending 1 to 2cm below the costal margin with inhalation. The kidneys are easier to palpate.

Question 56

abnormal findings in the aging adult

Answer 56

Abdominal rigidity with acute abdominal conditions is less common in aging.

With an acute abdomen, the aging person often complains of less pain than a younger person would.

Question 57

The nurse is percussing the seventh right intercostal space at the midclavicular line over the liver. Which sound should the nurse expect to hear?

A) Dullness
B) Tympany
C) Resonance
D) Hyperresonance

Answer 57

Dullness

Page: 541. The liver is located in the right upper quadrant and would elicit a dull percussion note.

Question 58

Which structure is located in the left lower quadrant of the abdomen?

A) Liver
B) Duodenum
C) Gallbladder
D) Sigmoid colon

Answer 58

Sigmoid colon

Page: 530. The sigmoid colon is located in the left lower quadrant of the abdomen.

Question 59

The nurse suspects that a patient has a distended bladder. How should the nurse assess for this condition?

A) Percuss and palpate in the lumbar region.
B) Inspect and palpate in the epigastric region.
C) Auscultate and percuss in the inguinal region.
D) Percuss and palpate the midline area above the suprapubic bone.

Answer 59

D) Percuss and palpate the midline area above the suprapubic bone.

Pages: 539-540. Dull percussion sounds would be elicited over a distended bladder, and the hypogastric area would seem firm to palpation.

Question 60

While examining a patient, the nurse observes abdominal pulsations between the xiphoid and umbilicus. The nurse would suspect that these are:

A) pulsations of the renal arteries.
B) pulsations of the inferior vena cava.
C) normal abdominal aortic pulsations.
D) increased peristalsis from a bowel obstruction.

Answer 60

normal abdominal aortic pulsations.

Pages: 538-539. Normally, one may see the pulsations from the aorta beneath the skin in the epigastric area, particularly in thin persons with good muscle wall relaxation. 

Question 61

A patient has hypoactive bowel sounds. The nurse knows that a potential cause of hypoactive bowel sounds is:

A) diarrhea.
B) peritonitis.
C) laxative use.
D) gastroenteritis.

Answer 61

B) peritonitis.

Page: 561. Diminished or absent bowel sounds signal decreased motility from inflammation as seen with peritonitis, with paralytic ileus after abdominal surgery, or with late bowel obstruction.

Question 62

The physician comments that a patient has abdominal borborygmi. The nurse knows that this term refers to:

A) a loud continuous hum.
B) a peritoneal friction rub.
C) hypoactive bowel sounds.
D) hyperactive bowel sounds.

Answer 62

hyperactive bowel sounds.

Pages: 539-540. Borborygmi is the term used for hyperperistalsis when the person actually feels his or her stomach growling.

Question 63

During an abdominal assessment, the nurse would consider which of these findings as normal?

A) The presence of a bruit in the femoral area
B) A tympanic percussion note in the umbilical region
C) A palpable spleen between the ninth and eleventh ribs in the left midaxillary line
D) A dull percussion note in the left upper quadrant at the midclavicular line

Answer 63

A tympanic percussion note in the umbilical region

Pages: 539-540. Tympany should predominate in all four quadrants of the abdomen because air in the intestines rises to the surface when the person is supine. Vascular bruits are not usually present. Normally the spleen is not palpable. Dullness would not be found in the area of lung resonance (left upper quadrant at the midclavicular line).

Question 64

. During an abdominal assessment, the nurse is unable to hear bowel sounds in a patient’s abdomen. Before reporting this finding as “silent bowel sounds” the nurse should listen for at least:

A) 1 minute.
B) 5 minutes.
C) 10 minutes.
D) 2 minutes in each quadrant

Answer 64

5 minutes.

Pages: 539-540. Absent bowel sounds are rare. The nurse must listen for 5 minutes before deciding bowel sounds are completely absent.

Question 65

A patient is suspected of having inflammation of the gallbladder, or cholecystitis. The nurse should conduct which of these techniques to assess for this condition?

A) Obturator test
B) Test for Murphy’s sign
C) Assess for rebound tenderness
D) Iliopsoas muscle test

Answer 65

Test for Murphy’s sign

Page: 551. Normally, palpating the liver causes no pain. In a person with inflammation of the gallbladder, or cholecystitis, pain occurs as the descending liver pushes the inflamed gallbladder onto the examining hand during inspiration (Murphy’s test). The person feels sharp pain and abruptly stops inspiration midway.

Question 66

During an assessment the nurse notices that a patient’s umbilicus is enlarged and everted. It is midline, and there is no change in skin color. The nurse recognizes that the patient may have which condition?

A) Intra-abdominal bleeding
B) Constipation
C) Umbilical hernia
D) An abdominal tumor

Answer 66

C) Umbilical hernia

Page: 537. The umbilicus is normally midline and inverted, with no signs of discoloration. With an umbilical hernia, the mass is enlarged and everted. The other responses are incorrect.

Question 67

The nurse suspects that a patient has appendicitis. Which of these procedures are appropriate for use when assessing for appendicitis or a perforated appendix? Select all that apply.

A) Test for Murphy's sign.
B) Test for Blumberg's sign.
C) Test for shifting dullness.
D) Perform iliopsoas muscle test.
E) Test for fluid wave.

Answer 67

B) Test for Blumberg’s sign.
D) Perform iliopsoas muscle test.

Pages: 543-544 | Page: 551. Testing for Blumberg’s sign (rebound tenderness) and performing the iliopsoas muscle test should be used to assess for appendicitis. Murphy’s sign is used to assess for an inflamed gallbladder or cholecystitis. Testing for a fluid wave and shifting dullness is done to assess for ascites.