Abdominal Assessment Flashcards
What should we ask the patient to do before performing an abdominal assessment?
- empty bladder
What position does the patient start in for an abdominal assessment?
- supine with UEs next to side unless otherwise noted
What side of the patient should we stand on as clinicans?
- right side and in position to observe facial reactions
What asymmetries are we observing for with an abdominal assessment?
- surface contour; any distention could be bowel obstruction, mass, etc
- swelling or ascites - possible indicated by inverted umbilicus
- umbilicus should be in midline
What kind of discolorations are we observing for with an abdominal assessment?
- jaundice with liver dysfunction
- ecchymosis indicating bleeding
- vein distention indicating liver or vena cava obstruction
What markings should we take note of with an abdominal assessment?
- scars
- rashes
- stretch marks
What can a pulsatile mass indicate with abdominal assessment?
abdominal aortic aneurysm but not unusual on lean individuals
What is peristalsis?
a wavelike motion that may indicate intestinal obstruction
What can sudden bulging with lifting the head or a cough indicate?
could indicate a hernia
What should we perform first in our abdominal assessment?
auscultations
Why should auscultations be performed first in our abdominal assessment?
to avoid altering bowel sounds
How long do we use the stethoscope to auscultate in each quadant?
2 minutes
What should we find for bowel sounds that are normal?
high pitched clicks and gurgling ever 5-10 seconds
What are ABNORMAL bowel sounds with auscultation?
- none= bowel obstruction particularly with cramping
- MORE = overactivity such as with lactose intolerance
Where is the abdominal aorta?
- just left to midline and umbilicus at peri-stenal line
What indicates turbulent blood flow of the AA?
Bruits
How should we percuss during an abdominal assessment?
- hyperextend and apply firm pressure with the non-dominant and distal aspect of the middle finger
- avoid contact with any other part of the hand
- position dominant hand close to surface with wrist extended
- strike the non-dominant middle finger quickly and sharply with the flexed dominant middle finger
How many times can we strike with percussions during an abdominal assessment?
twice
What are “normal sounds” with percussions during an abdominal assessment?
- tympanic or hollow sound over stomach and bowels or more air filled organs unless one is full
- deep resonance or lasting sound over thorax and lung
- dullness over more solid or full organs or even tumors
What organs should produce a dull sound with percussions?
- liver
- heart
- diaphragm
- spleen
- etc.
Where is the stomach located (for percussion of the stomach)?
- close to left lower rib cage, just inferior to sternum
What sound should the stomach make?
- tympanic or hollow sound if empty, otherwise dull if full
Where do we perform mid-clavicular percussion of the liver? What sounds should we expect?
- just above the umbilicus, along right mid-clavicular line
- progress superiorly
- starts with tympany or hollow sound of bowel
- changes to dullness at liver for ~ 2.5 - 5 inches
- resonance of lung tissue begins superior to liver
What is abnormal with mid-clavicular percussion of the liver?
Larger area of dullness
Where do we perform anterior axillary line percussion of the spleen? What sounds should we expect?
- starts at left lower rib cage anterior axillary line
- tympany or hollowness should be produced
- move posteriorly toward mid-axillary line, it should become dull
- dullness should be present between 9th and 11th ribs
What is ABNORMAL with anterior axillary line percussion of the spleen?
- dullness noted more medially and inferiorly
- more dullness while inspiring
What is the Murphy Test?
- kidney percussion in sitting or prone with a firm fist thumping on contralateral flat hand over costovertebral angle looking for pain
How do we start palpations?
start with firm, light pressure in a slow circular fashion within each quadrant
What kind of hand contact do we want with palpations during our abdominal assessment?
- broad hand contact and possibly palpate through patients hand
Where is our forearm during palpations of the abdomen?
in the same plane as the abdomen
What should we do if no resistance or symptom provocation during palpations?
apply deeper pressure
What are we looking for with palpation, other than pain?
masses and muscle guarding
What is NORMAL for palpations?
pressure
What is abnormal for palpations?
- tenderness or muscle guarding
What can tenderness or muscle guarding during palpation indicate?
swelling or dysfunction
How should we confirm for a similar response if we find tenderness or muscle guarding with palpation?
with percussion or cough
How do we assess for rebound tenderness?
applying pressure then quickly releasing
What does crepitus or crunchiness indicate with palpation?
excess air
Where are hernias common?
around umbilicus and inguinal areas, larger with trunk flexor activity such as crunch, cough, etc.
What can also be palpated with our abdominal assessment?
mass or cyst
What is gastritis?
Stomach inflammation over epigastric area, just inferior to sternum
What is diverticulitis?
Intestinal inflammation in the left lower quadrant
Where would we feel for appendicitis?
right lower quadrant between ASIS and umbilicus
Where would we palpate for hepatitis (liver inflammation)?
right upper quadrant, ask the patient to exhale and slowly move deeper during inhalation
- inferior border is palpable
Where would we palpate for panreatitis?
mid-clavicular line in right upper quadrant with max exhalation, press and hold deeper pressure while patient is inhaling
Where do we palpate for the spleen?
- left lower rib cage at anterior axillary line, ask patient to exhale and slowly move deeper during inhalation under the rib cage
Is the spleen palpable if no pathology?
NO
How do we palpate the abdominal aortic artery?
- hook lying
- utilize two index fingers
- find pulse just to the left of the umbilicus or left peri-sternal line and assess up and down abdominal region
What are we assessing about the aortic artery?
- strength
- width by slowly moving fingers apart
What are the strength grades for pulses?
0 = absent
2+ = normal
4+ = bounding
What is the normal width of the abdominal aortic artery?
~1 inch (2.54cm)
What could we find that is ABNORMAL regarding the abdominal aortic artery?
- ≥ 3 cm may indicate aneurysm then confirm with auscultation
- provoke back pain
What dermatomes can we assess during our abdominal assessment?
T7-12 dermatomes with light and sharp touch from xiphoid process to inguinal lig
What are we assessing the superficial abdominal reflex for?
UMN lesion
How do we assess the superficial abdominal reflex?
- diagonally strike from umbilicus to outer border of each quadrant
- umbilicus should move in the direction of the stroke
