Abdominal Assessment Flashcards
What would you say at the beginning of the abdominal assessment? (Introduction)
I have done my history taking and general assessment and ascertained that I now need to do an abdominal assessment.
For this assessment, I need the patient lying flat on their back to fully relax the abdominal cavity.
The patient can bring their knees up to further relax the abdomen.
I am going to ask my patient to fully expose the abdomen, usually for this assessment they would be exposed nipples to knees, but this would be inappropriate for an OSCE.
I am going to ask my patient throughout the examination if they experience any pain at all, to let me know. I will be looking at their face throughout the examination to see if they are showing any signs of pain during the examination.
What are you looking for in the abdominal inspection?
“Sophie Swears By Visiting Someone Happy At Dawn”
1. Symmetrical?
2. Scars?
3. Bruising?
4. Vessels?
5. Striae?
6. Hair Distribution?
7. Ascites?
8. Distension?
What could asymmetry in the abdomen be?
A tumour, organomegaly
What scars might you find on the abdomen?
McBurney’s Point - Appendectomy
Hypogastric bikini line scar - Previous C Section
What are the two types of bruising found on the abdomen, and what do they indicate?
- Umbilical bruising - Cullen’s Sign - Internal bleeding or pancreatitis
- Flanks bruising - Grey-Turner Sign - Internal
bleeding or pancreatitis
What are you looking for under “vessels” of the abdominal assessment?
- Spider Naevi - Indicative of liver disease. >3 is not normal.
- Caput medusae - Engorged veins around umbilicus - sign of portal hypertension
What are pink/purple stretch marks indicative of?
Cushing Syndrome - too much cortisol in the body
What are grey stretch marks indicative of?
Quick weight loss or weight gain/pregnancy
What is Linea Nigra indicative of?
Pregnancy
What can abnormal hair distribution in females indicate?
Polycystic Ovary Syndrome (PCOS)
What are the 6 F’s of distension?
Fluid
Fat
Flatus
Faeces
Foetus
F***ing big Tumour
What is not normal when looking for pulsations in the abdomen?
Fingers being shifted when you palpate the aorta, and expansive pulsation, which you can see across the whole abdomen
What is a hernia?
An organ that protrudes through muscle
Where are the most common places for hernias?
Epigastric region
Umbilical region
Femoral region (females)
Inguinal region (males)
What do you do if there is a hernia?
Try and push it back in.
If it does not go back in or it is painful, this should be referred
What is the 1st abdominal region, and what are the underlying organs?
Right Hypocondriac
Liver, Gallbladder, Right Kidney, Small Intestine
What is the 2nd abdominal region, and what are the underlying organs?
Epigastric region
Stomach, Liver, Pancreas, Spleen
What is the 3rd abdominal region, and what are the underlying organs?
Left Hypochondriac
Spleen, Stomach, Left Kidney, Pancreas
What is the 4th abdominal region, and what are the underlying organs?
Right Lumbar
Gallbladder, Liver, Right Colon
What is the 5th abdominal region, and what are the underlying organs?
Umbilical region
Small intestine, Abdominal Aorta, Duodenum
What is the 6th abdominal region, and what are the underlying organs?
Left Lumbar
Left Kidney, Descending Colon
What is the 7th abdominal region, and what are the underlying organs?
Right Iliac
Appendix, Cecum
What is the 8th abdominal region, and what are the underlying organs?
Hypogastric region
Bladder, Female reproductive organs
What is the 9th abdominal region, and what are the underlying organs?
Left Iliac
Descending colon
What are you palpating the abdomen for?
Pain / tenderness
Lumps
Guarding
Masses
What could masses be in the abdomen?
6 F’s:
Fat
Flatus
Foetus
Flatus
Fluid
F***ing big tumour
What is guarding?
An involuntary spasm of muscles around a site of injury or illness
What could pain in the LLQ indicate?
Diverticulitis
What is the rebound tenderness test?
Find the line between the umbilicus and superior iliac crest - go 1/3 of the way up from the crest to find McBurney’s point. Deeply press this point and release suddenly - if pain on release - positive for appendicitis.
What is Rosving’s sign?
Push in on the LLQ and if there is pain in the RLQ - this could indicate peritonitis or appendicitis
What is ascites and what is it caused by?
An excess of fluid in the abdominal cavity, indicating liver cirrhosis, caused by portal hypertension
What is the first test for ascites?
Shifting dullness:
Percuss from the umbilicus in a straight line towards you, and when the sound turns from tympany to dullness, tape that line.
Ask the patient to roll towards you for 30 seconds, and then percuss again. The line should have moved upwards - which would indicate ascites in the abdomen.
What is the second test for ascites?
Fluid thrill:
Ask the patient to put the ulnar aspect of their hand above their belly button. You put your hand on the far side of the abdomen and the opposite side. If there is ascites, the tap will send a shockwave to the other side.
What should and shouldn’t the liver feel like on palpation?
Smooth and angular.
If it is rough - this could indicate liver cirrhosis.
If it is easy to palpate / protruding below the ribs - this could indicate hepatomegaly.
What is Murphy’s sign and how do you do it?
A positive indication for cholecystitis (inflammation of the gallbladder).
Palpate under the ribs in the RUQ, ask patient to take a deep breath in - if there is pain on inspiration - positive sign.
What patients is cholecystitis most prevalent in?
4F’s -
Female, Fat, Forties, Fare
How do you palpate the spleen, and what are you supposed to feel?
Ask the patient to take a breath in, start palpating from the right iliac crest up towards the LUQ.
You should not be able to palpate the spleen - but if you can then it could be enlarged - splenomegaly (due to potential infection)
How do you palpate the kidneys and what are you supposed to feel?
Place one hand on the patient’s back and one hand on the RUQ and push down - look at the patient’s face for any signs of pain.
If the kidneys are not inflamed - you shouldn’t be able to feel them.
If you can feel them or there is pain - indicative of upper UTI or pylenophritis.
How would you talk through a rectal examination?
“Ordinarily this would not be performed in the ambulance service environment - however we need to note whether it has or has not been performed.
Ask if one has been performed recently - what were the results?
Patient should lie in the left lateral position with knees tucked up into chest.
Gloved and lubricated index finger inserted into the anus
Feel the 4 quadrants of the rectum for pain, bleeding, faeces, prostate (male) and the cervix (female)”
What are you expecting to hear when percussing the abdomen? What are abnormal findings?
Expecting a tympanic sound - like a drum.
Hyporesonance (dull) indicates a solid / fluid / organ
How do you percuss the liver borders?
Ask the patient to empty their lungs, and percuss down the mid-clavicular right hand side of the patients chest.
The sound will be tympanic until you hit the liver, when it becomes dull.
Then percuss upwards from the right iliac crest until its dull.
Mark the points where it is dull and measure - should be between 6-12cm.
If >12cm - could indicate hepatomegaly, malignancy, hepatitis or liver cirhhosis.
Where does the top of the liver usually sit?
Mid clavicular line, 5th ICS, right sternal border.
How many bowel sounds should you hear in a minute?
5-30
If you hear over 30 bowel sounds in a minute, what does this indicate?
A hyperactive bowel - diarrhoea
If you hear under 5 bowel sounds in a minute, what does this indicate?
An underactive bowel - constiptation
If you hear no bowel sounds, what does this indicate?
A bowel obstruction - an emergency
If you hear tinkling sounds when auscultating the bowel, what does this indicate?
That the bowel is about to obstruct
How should you auscultate the abdomen?
Start auscultating just right of the umbilicus for a minute (general bowel sounds). Then auscultate each quadrant for a minute.
What vasculature should you auscultate in the abdomen?
The aorta, the renal arteries and the iliac arteries?
Where are the vasculature situated in the abdomen to auscultate?
Aorta - Just above the umbilicus
Renal arteries - 2cm above the umbilicus and 2cm to the left and right
Iliac arteries - 2cm below the umbilicus and 2cm to the left and right
You should use the ______ of the steth to listen to the abdominal vasculature
bell
What are normal sounds for the vasculature of the abdomen?
No sounds
Whooshing - bruits
What is in your “inspect” section of the abdominal assessment?
- Abdominal inspection (SSBVSHAD)
- Aortic pulsations
- Hernia assessment
What is in your “palpate” section of the abdominal assessment?
- Light and deep palpation
- Rebound tenderness
- Ascites test
- Liver and gallbladder palpation
- Spleen palpation
- Kidney palpation
- Rectal examination
What is in your “percuss” section of the abdominal assessment?
- Percuss 4 quadrants
- Percuss liver borders
What is in your “auscultation” section of the abdominal assessment?
- Auscultate 4 quadrants + right of umbilicus
- Auscultate vasculature for bruits
