Abdomen Techniques of Examination

Question 1

Positioning/techniques for relaxed abdomen

Answer 1

Arms at side
Bend knees
Open jaw mouth breath
Exhale

Question 2

Bowel sounds

Answer 2

5-34/min

Ok to ausculate in one quadrant ie RLQ as sound reverberates

Question 3

Borborygmi

Answer 3

Stomach growling

Question 4

Friction rubs over liver spleen or mass

Answer 4

Hepatoma
Gonococcal infection of liver
Splenic infarction
Pancreatic carcinoma

Question 5

Locate palpation sites of…

Answer 5

Aorta
Renal arteries
Iliac arteries
Femoral arteries

Question 6

Assess for peritonitis

Answer 6

positive cough test 
Involuntary guarding 
Rigidity 
*rebound tenderness
Percussion tenderness

Question 7

Percussion of liver

Answer 7

Mid rt clavicular line
*heavy strike underestimates liver size
Start below umbilicus for lower border
At nipple line for upper border

Question 8

Palpation of liver

Answer 8

Right midclavicular line
Press in and up
Palpable 3cm below right costal margin on inspiration
Hooking technique for obese pts

Question 9

Movement of enlarged spleen

Answer 9

Anteriorly, medially, and downward

Question 10

Traube space

Answer 10

Percuss for spleen
L anterior chest
6th rib to anterior axillary line

Question 11

Percussion of spleen

Answer 11

Normal tympany
Abnormal dullness
Percuss after deep inhalation (castell’s sign)

*edge 2cm below left costal margin upon inspiration in enlargement

Question 12

Castell sign

Answer 12

Percus spleen after large inhale

Abnormal dull

Question 13

Palpation of kidneys

Answer 13

Kidneys not palpable unless markedly enlarged

Question 14

Technique of cva percussion

Answer 14

Strike your hand with ulnar surface of fist to r/o pyelonephritis

Question 15

Palpation of bladder

Answer 15

Not palpable above symphis pubis unless distended

Question 16

Percussion of bladder

Answer 16

No dullness before 400-600cc

Question 17

Palpation of aorta

Answer 17

Deep to epigastrum
<3cm in adults over 50
Palpate with hands on either side of aorta

Question 18

Ascites assessment

Answer 18

Protuberant abdomen with bulging flanks
Dependent edema
(Ask them to roll)
Mark border of tympany and dullness

Question 19

Causes of ascities

Answer 19

Liver cirrhosis
Heart failure 
Hepatic vein obstruction 
IVC obstruction 
Ovarian CA 
Nephrotic syndrome 
Malnutrition

Question 20

Ballottement

Answer 20

Join fingers and jab to palpate organs in obese pts

Question 21

Indication of appendicitis

Answer 21

RLQ pain

Question 22

Rovsing sign

Answer 22

Deep palpate LLQ then remove fingers

For appendicitis

Question 23

McBurney’s sign

Answer 23

Tenderness upon palpation of McBurney’s point for appendicitis
2” from anterior superior iliac spine on a line to the umbilicus

Question 24

Psoas sign

Answer 24

Contract and extend psoas muscle RLE
Lift rt knee against examiner hand
Extend leg
For appendicitis

Question 25

Obdurator sign

Answer 25

Appendicitis
Low specificity
R hypogastric pain upon internal rotation of RLE with knee bent

Question 26

Murphy’s sign

Answer 26

For cholecystitis
Deep palpation of RUQ
Ask pt deep breath
Sharp inhalation (pain)

Question 27

Ventral hernia

Answer 27

Hernia not in groin

Question 28

If suspected ventral hernia not palpated…

Answer 28

Valsalva or raise both legs to increase intra abdominal pressure

Question 29

Do not confuse ventral hernia with…

Answer 29

Diastasis recti (post partum or obese)

Question 30

Distinguish ab wall from intraabdominal mass

Answer 30

Tighten abs