Abdominal Assessment

Question 1

Abdominal Inspection Topics

Answer 1

• abdomen
• hands
• face
• pain
• lymph nodes/spider nevi

Question 2

Inspection of Lymph Nodes and Spider Nevi

Answer 2

• enlarged virchows window (left of clavicle) = cancer, abdominal pathology
• over 6 spider Nevis = pregnancy, liver disease

Question 3

Inspection of Abdomen

Answer 3

• shape, symmetry, scarring
• obvious distension/hernia (5Fs)
• normal pulsations = AAA
• Turner sign (flank bruising) = retroperitoneal bleeding from acute pancreatitis
• cullens sign (umbilicus bruising) = haemmorhagic pancreatitis
• New/red stretch marks = sudden weight loss or gain

Question 4

Pain Assessment

Answer 4

• can the Lt lie flat without pain? = pancreatitis
• cough without pain when flat? = peritonitis

Question 5

Hands Inspection

Answer 5

• dupuytrens contracture? = diabetes
• leukonychia = liver, Pb poisoning, chemo
• Palmer erythema? = liver disease
• asterixes? = liver disease
• clubbing? = CO2 retention and liver disease
• brittle nails = malnutrition

Question 6

Face Inspection

Answer 6

• Jaundice around the face and eyes?
• mucous membrane should be oink
• furry tongue = dehydration
• any dental problems?

Question 7

Auscultation Topics/Procedures

Answer 7

• abdomen auscultation
• bowel sounds
• bruits

Question 8

Auscultating the Bruits

Answer 8

• listen to all arteries for normal wooshing sounds
• aorta
• Iliac artery
• left renal artery
• femoral artery

Question 9

Normal Bowel Sounds

Answer 9

Normal:
- high pitched, furling, varying in Fra, 5-30 p/min
- louder before food
- furling/growling = food passing through GI tract

Question 10

Abnormal Bowel Sounds

Answer 10

Hyperactive = diarrhoea, laxative use
Hypoactive = fluid, opoit use, constipation?
Abscent = bowel obstruction
Tinkling/Squeal - early obstruction

Question 11

Abdomen Auscultation

Answer 11

• listen to all 9 regiond
• must be lying flat
• listen to each quadrantfor 1-3 minutes
• listen on direct skin

Question 12

Abdominal Palpation Topics

Answer 12

• abdomen
• appendix
• gall bladder
• kidneys

Question 13

Gall Bladder Palpation

Answer 13

• Murpheys sign - deep breath in, palpate right hypochondriac
• pain/feeling indicates enlarged fall bladder/cholecystitis

Question 14

Palpating the Kidneys

Answer 14

• palate ant/post when pt takes deep breath
• shouldn’t be able to pallate
• just below the costal margin

Question 15

Palpating the Appendix

Answer 15

Rovsings sign - pain at McBurneys point
- any rebound tenderness?
PPSOAS test - straight leg raise = appendicitis

Question 16

Palpatng the Abdomen

Answer 16

• start away from the pain
• observe any guarding/boarding
• rebound tenderness? = peritonitis
• feel for masses, hernia, fluid or pain
• finish in the area of pain
• Light and deep palpation in all 9 regions

Question 17

Abdominal Percussion Topics

Answer 17

• abdomen
• spleen
• liver
• shifting dullness

Question 18

Shifting Dullness

Answer 18

• have the pt supine
• lercuss down from the umbilicus left laterally until dull
• keep finger in place while Lt rolls to other side
• wait 30 seconds
• lercuss the same place = if fluid has shorten then will now be tympanic
• usually seen in alcohols dependancy pts

Question 19

Percussing the Abdomen

Answer 19

• percuss across all 9 regions
• tympanny (air) = hollow and normal
• dull = organ, faceses, fluid, tumour, obstruction
• percuss multiple times in one quadrant

Question 20

Percussing the Spleen

Answer 20

• find the lowest intercostal space
• should be tympanic
• if enlarged would be dull

Question 21

Percussing the Liver

Answer 21

• percuss down from the 4th intercostal space mid-clavicular line until dull
• make a mark
• percuss up from umbilicus, mid-clavicular line until dull
• Normal = 6-12cm
• enlarged caused by infection, heart disease