Abdominal

Question 1

General Inspection

Answer 1

Pt is supine

• inspect skin for scars, lesions, tattoos
• inspect for size, contour, symmetry of abdomen
• observe for visible peristalsis and aortic pulsations
• have patient lift head then observe for masses, hernias, or separation of muscles

Question 2

Auscultation

Answer 2

Use diaphragm, listen to all 4 quadrants. Normal bowel sounds around between 5-34 sounds per minute. Must listen for 5 minutes to declare absence of sounds

Question 3

Palpation

Answer 3

Ask pt if they are tender anywhere, start farthest away from that area.

• lightly palpate with one hand all 4 quadrants
• use two hands for deep palpation, describe any masses felt
• palpate liver: place left hand behind pt supporting 11-12 ribs, place right hand in RUQ, have pt take a deep breath and try to trace edge of liver

Question 4

Auscultation for bruits

Answer 4

Use bell. Check aortic (slightly to left of midline), renal (on both sides of aorta in epigastric area), and iliac (on both sides of aorta just below umbilicus

Question 5

Percussion

Answer 5

Percuss all 4 quadrants. Should hear tympany but dullness can be expected due to stool and liver.
- liver: start RLQ, percuss up midclavicular line until dullness is heard. Then start at R side of chest below breast ad percuss down to dullness. Space between should be 6-12 cm

Question 6

Additional Palpation

Answer 6

• Murphy’s Sign: palpate below liver margin on RUQ and ask patient to take a deep breath. Pain is positive.
• McBurney’s Point: Press firmly with fingers at 90 angle in RLQ, release quickly. Pain with rebound is positive.
• Spleen: With Left hand reach around and support right cage forward, with R hand press below left costal margin. Have patient take a deep breath. Repeat with patient lying on R side with legs and hips slightly flexed.
• Aorta: press firmly and deeply into upper abdomen, slightly to L of midline. Feel for pulsations. Try to measure width.

Question 7

Rebound tenderness

Answer 7

press firmly with fingers at 90 into abdomen and release quickly. Pain with release is positive. If LLQ is positive, could be referred rebound.

Question 8

CVAT

Answer 8

Place one hand flat against costovertebral angle and strike with fist of other hand with enough force to make a thud.