Abdominal Assessment

Question 1

What are the four main components to this assessment

Answer 1

Inspection, Auscultation, palpation, percussion

Question 2

What does the end of bed assessment involve assessing?

Answer 2

How does the patient look, hydration status, body mass, fever, pain, environment e.g vomit bowls

Question 3

What should we start with in the physical assessment

Answer 3

Hands

Question 4

What can clubbing be an Indication of?

Answer 4

Inflammatory bowels disease, coeliac disease and cirrhosis

Question 5

What can koilonychia be an indication of

Answer 5

Anaemia

Question 6

What can palmar erythema show

Answer 6

Possible pregnancy or liver disease

Question 7

What can needle use marks show?

Answer 7

Recent blood tests, or IV and recreational drug use

Question 8

What can depuytrens be an indication of?

Answer 8

Thickening of the palmar fascia which can be associated with alcohol excess or family history

Question 9

What can a liver flap or Astérix show?

Answer 9

Hepatic encephalopathy due to build up of ammonia in the brain - get them to hold out their hands for 15 seconds

Question 10

After three hands where do we inspect next?

Answer 10

Head and neck

Question 11

When looking at the face what are we looking for?

Answer 11

Jaundice which may be an indication of a build up of bilirubin and pallor which may indicate GI bleeding

Question 12

How do we test conjunctival pallor?

Answer 12

Ask the patient to pull their lower eye lid down and look up, if it is white it may indicate anemia

Question 13

What can blue lips Indicate?

Answer 13

Lack of oxygen - cyanosis

Question 14

Why should you also check their tongue

Answer 14

For grossitis - indication of herpes or anaemia

Question 15

What should you inspect and look for on the body

Answer 15

Scars, bruising, cullens, hernias, masses, pulsations, spider Nivea, caput medusa and distension

Question 16

How many quadrants are there that you must listen to?

Answer 16

4

Question 17

What is the normal sound that should come from auscultation

Answer 17

Gurgling

Question 18

What is the next step after auscultation

Answer 18

Palpation

Question 19

What areas do you assess last

Answer 19

The ones where the patient said are painful

Question 20

What are we looking for when we palpate lightly

Answer 20

If there is any tenderness, rebound tenderness, guarding (involuntary tension in the abdominal muscles), masses

Question 21

What do we do after we have palpated lightly

Answer 21

Palpate all 9 areas deeply

Question 22

What else can you do other than palpate the liver?

Answer 22

Percuss the liver but the note changes in sound

Question 23

Where do you begin the palpitation in the liver?

Answer 23

Begin in the right illiac fossa using the flat edge of your hand, press your hand into the abdomen as you ask your patent to take a deep breath.
Feel for a step as the liver edge passes below your hand.

Question 24

When does the spleen become palpable ?

Answer 24

When it’s 3 times its normal size

Question 25

How do you palpate the spleen?

Answer 25

Starting at the right iliac fossa align your fingers in the same direction as the left costa margin, press your hand into the abdomen as you ask the patient to take a deep breath. Feel for the splenic edge as it passes under your hand. If you cannot feel anything repeat the process with your hand 1 or 2 cm closer to the left hypochondria.

Question 26

How do you palpate the gall bladder

Answer 26

The gall bladder is not normally palpable, place your hand in the right coastal margin, mid clavicular line
Ask the patient to take a deep breath, as the gallbladder is pushed down the patient may suddenly develop pain. If this happens and the patient doesn’t feel any discomfort on the left side of the abdomen then they are Murphy’s sign positive which suggests cholecytisis

Question 27

What are the tests for appendicitis?

Answer 27

Rovsings sign, the psoas sign, obturator sign

Question 28

What is the last step after palpitation

Answer 28

Percussion

Question 29

What is the percussion technique?

Answer 29

Place your non dominant hand on the patients abdomen, position your middle finger over the area you want to percuss firmly pressed against the abdomen.
With your dominant hands middle finger strike the middle phalanx of the other hands middle finger.
The striking finger should be removed quickly.
Dull sounds suggest a solid organ or obstruction if you hear it over an organ where a hollow organ is expected.

Question 30

What are we constantly checking about the arms and legs

Answer 30

The temperature