Abdominal

Question 1

What are the major components of the abdominal exam?

Answer 1

Inspection

• contour
• symmetry
• umbilicus
• skin
• pulsation or movement
• hair distribution
• demeanour

Auscultation

• bowel sounds
• note any vascular sounds

Percussion
-all four quadrants

Palpation
-light in all four quadrants

Question 2

how is the contour of the abdomen inspected?

Answer 2

• shine light tangentially to abdomen
• stand on right side of patient
• look down at abdomen then stoop or sit to gaze across it
• determine profile
• normal finding is flt or round profile

Question 3

what is inspected about the abdomen

Answer 3

• contour
• symmetry
• umbilicus
• skin
• pulsations or movements
• hair distribution
• demeanor

Question 4

how is the symmetry of the abdomen inspected?

Answer 4

with light shining tangentally across abdomen towards you, look for bilateral symmetry

• have patient take a deep breath
• go to foot of examination table and recheck symmetry
• ask patient to take a deep breath

Question 5

what is inspected about the umbilicus in the abdominal examination?

Answer 5

colour - no redness or discolouration
position - midline
hernia - no hernia or swelling

Question 6

what should be inspected about the skin

Answer 6

• surface - should be smooth and even with no abnormal palpations
• note and measure as well as document any scars or striae
• check turgor

Question 7

what is auscultated in the abdominal examination?

Answer 7

bowel sounds

vascular sounds

Question 8

how are bowel sounds assessed?

Answer 8

• using diaphragm of stethoscope
• listen in each quadrant starting in right lower quadrant, where iliocecal region is
• should listen in clockwise progression to each quadrant
• expect to hear high pitched and gurgling sounds at frequency of approximately 5-30 sounds per minutes

Question 9

how are vascular sounds assessed in the abdominal examination

Answer 9

• use bell of stethoscope
• listen for buits, none should be heard however
• listen over aorta
• listen over renal arteries
• listen over iliac arteries
• listen over femoral arteries

Question 10

how is abdomen percussed?

Answer 10

• gently percuss staring in right lower quadrant in zigzag pattern (start near umbilicus, then go down to femoral region at midclavicular line)
• percuss in zigzag pattern over midclavicular line up to lower border of ribs, across and then down left midclavicular line
• tympany should be predominant sound

Question 11

how is the abdomen palpated?

Answer 11

• have patient bend knees to help relax/soften muscles
• lightly
• using finger pads, finger tips together
• making a gentle rotary motion to depress 1 cm
• lifting between each site
• no tenderness, rigid areas or masses are expected