Abdominal Assessment Flashcards

Question

Why is percussion used and what should you feel, listen for?

Answer 1

-Percussion of the abdomen is used to help you to assess the amount and distribution of gas in the abdomen and to identify possible masses that are solid or fluid filled. It can also be used to estimate the size of the liver and spleen. -Percuss the abdomen lightly in all four quadrants moving clockwise to assess the distribution of tympany and dullness......... Tympany usually predominates because of gas in the GI tract.....but scattered areas of dullness and fluid from faeces are also typical. A protuberant abdomen that is tympanitic throughout suggests intestinal gaseous obstruction. -Percussion is also useful for assessing peritoneal tenderness.........sharp pain. Abdominal pain when coughing or with light percussion suggests peritoneal inflammation. Percussion can stimulate and cause peritoneal pain.

Answer 2

-Light palpation first to about 1 cm depth, keep your hand low and flat no sharp prodding that could make the patient tense up, palpate the abdomen with light , gentle dipping motion. Keep your voice low and soft to help the patient relax and use imagery if necessary (Sunny beaches, warm sand, etc). Mild tenderness is normal over the sigmoid colon. Ensure you lift your hand prior to moving to the next quadrant do not drag and move clockwise. Start away from painful area. Feeling the abdomen gently is especially helpful for identifying abdominal tenderness, muscular resistance and some superficial organ enlargement and masses. It also serves to reassure and relax the patient. If resistance is present try and distinguish between voluntary guarding and involuntary muscular spasm. Voluntary guarding .............occurs when the person is cold, tense or ticklish and is normally felt bi-laterally. Feel for the relaxation of abdominal muscles that normally accompanies exhalation. If a patient is particularly ticklish you can put your hand on top of the patient’ hand initially to overcome this. Involuntary rigidity................is constant and board-like. It is a protective mechanism, accompanying acute inflammation of the peritoneum. It can be uni-lateral and the same area will elicit pain when the patient attempts to sit up. A board like rigidity is a serious sign. Following light palpation instigate deep palpation of the abdomen in all quadrants (4-6 cm deep) (this will be painful if the practitioner has long nails). With obese patients two hands may be required. Localise the pain as accurately as possible.....ask patient to cough to help localise the pain. Then palpate gently with one finger attempting to map out the exact area of tenderness If a mass is found you need to record; Location Shape Size Consistency Surface (nodular or smooth) Mobility (fixed or free) Pulsatility Tenderness -Rebound tenderness – pain is worsened on releasing the pressure – peritonitis

Answer 3

Hook fingers under the liver border ask patient to deep breath The liver descends during inspiration and the gall bladder will push against your hand When this happens the patient may stop inspiration because it is painful. This is then said to be positive. 60 year olds - this test is unlikely to elicit the same result as 25% are shown not to have any tenderness. A positive Murphy’s sign is associated with cholecystitis

Answer 4

-Procedure: 1. The healthcare provider applies deep pressure to the left lower quadrant of the patient’s abdomen. 2. The pressure is then gradually released while observing the patient's response. 2. Positive Rovsing’s Sign: 1. If the patient feels pain in the right lower quadrant when pressure is applied or released from the left lower quadrant, this is considered a positive Rovsing’s sign. 2. The pain occurs due to the shifting of gas or the movement of the peritoneum, which causes irritation of the inflamed appendix on the right side. Why It’s Useful: * A positive Rovsing’s sign strongly suggests appendicitis, as the referred pain indicates inflammation of the peritoneum near the appendix. * It complements other clinical signs (e.g., McBurney’s point tenderness, Psoas sign) to strengthen the suspicion of appendicitis. In summary, Rovsing’s sign tests for referred pain in the right lower quadrant when pressure is applied to the left lower quadrant, aiding in the diagnosis of acute appendicitis.

Answer 5

If palpation does not establish an area of peritoneal inflammation then attempt to elicit rebound tenderness. Press down with your fingers firmly (no long nails again) and slowly, then withdraw them quickly. Watch and listen to the patient for signs of discomfort..........ask the patient if it hurts more pressing down or when removing fingers........pain induced or increased by quick withdrawal constitutes rebound tenderness caused by rapid movement of an inflamed peritoneum associated with an appendicitis.

Answer 6

The Psoas sign is a clinical test used to help diagnose appendicitis or other conditions causing irritation of the psoas muscle in the abdomen. It specifically tests for inflammation near the right iliopsoas muscle, which can become irritated when the appendix is inflamed, particularly in cases of retrocecal appendicitis (when the appendix is positioned behind the cecum). How the Psoas Sign Test Works: 1. Positioning: 1. The patient is usually lying on their back (supine) or on their left side. 2. Procedure: There are two ways to test for the Psoas sign: 1. Passive extension method (more common): 1. The patient lies on their back while the healthcare provider gently extends (pulls backward) the patient’s right leg at the hip joint, keeping the knee straight. 2. This stretches the psoas muscle. 2. Active flexion method: 1. The patient lies on their left side, and the healthcare provider extends the right leg backward, asking the patient to actively flex (lift) the right leg against resistance. 2. Flexing the hip contracts the psoas muscle. 3. Positive Psoas Sign: 1. If the patient experiences pain in the lower right quadrant of the abdomen during either maneuver, the test is considered positive. 2. This pain occurs because stretching or contracting the psoas muscle causes irritation to the inflamed appendix, especially when the appendix is located close to or behind the psoas muscle. Why It’s Useful: * The Psoas sign is particularly helpful for diagnosing retrocecal appendicitis, where the appendix is positioned behind the cecum and can irritate the iliopsoas muscle, leading to pain. * It can also be used to differentiate appendicitis from other causes of abdominal pain, especially if pain is absent with other common tests (like McBurney's point palpation). In summary, the Psoas sign test looks for pain with stretching or contraction of the psoas muscle, which can indicate appendicitis or other abdominal inflammation near the muscle

Answer 7

Mc Burney’s Point is the name given to the area exactly above the appendix.

Answer 8

he McBurney’s point test is a clinical test used to help diagnose appendicitis, specifically by identifying tenderness at a specific location on the abdomen. McBurney’s point is a spot on the lower right side of the abdomen, and tenderness in this area is a key indicator of appendicitis. How the McBurney’s Point Test Works: 1. Location of McBurney’s Point: 1. McBurney’s point is located about 1/3 of the way along a line drawn from the right anterior superior iliac spine (the front of the hip bone) to the umbilicus (belly button). 2. Procedure: 1. The doctor or healthcare provider palpates (presses) on McBurney’s point to assess for tenderness or pain. 2. The patient is asked whether they feel pain when pressure is applied, and they are also observed for signs of discomfort or guarding (involuntary tightening of the abdominal muscles). 3. Positive McBurney’s Point Sign: 1. If pressing on McBurney's point produces severe localized pain, this is a strong indication of acute appendicitis. 2. Rebound tenderness may also be tested, where the examiner applies pressure and then quickly releases it. If there is increased pain upon releasing the pressure, it suggests peritoneal irritation, a sign that the appendix may be inflamed or ruptured. Why It’s Useful: * Localized pain at McBurney's point correlates with the location of the appendix, especially in the early stages of appendicitis when the appendix is inflamed but not yet ruptured. * It helps differentiate appendicitis from other causes of abdominal pain, especially if combined with other symptoms like fever, nausea, and elevated white blood cell count. However, not all cases of appendicitis present with pain at McBurney’s point, as the appendix can vary in its position in the abdomen, especially in children or pregnant women, where the appendix may be displaced. Therefore, the McBurney’s point test is one part of a broader clinical assessment for appendicitis.

Answer 9

The Obturator sign is a clinical test used to help diagnose appendicitis, particularly when the inflamed appendix is located in the pelvis. It tests for irritation of the obturator internus muscle, which can be affected when an inflamed appendix is in close proximity. How the Obturator Sign Test Works: 1. Positioning: 1. The patient lies on their back (supine). 2. Procedure: 1. The healthcare provider lifts the patient’s right leg and flexes the hip and knee to 90 degrees (bending the leg at the hip and knee). 2. The provider then internally rotates the hip by gently moving the patient’s ankle outward while keeping the knee stationary. This movement stretches the obturator internus muscle. 3. Positive Obturator Sign: 1. If the patient experiences pain in the lower abdomen, particularly in the right lower quadrant, during this maneuver, it is considered a positive Obturator sign. 2. This pain occurs because the internal rotation of the hip causes the obturator internus muscle to rub against the inflamed appendix, especially if the appendix is located in the pelvis or lower right part of the abdomen. Why It’s Useful: * The Obturator sign is particularly helpful when the appendix is located in the pelvis or if there is suspicion of pelvic appendicitis, which might not cause the usual pain in the typical McBurney’s point area. * Along with other clinical signs (such as McBurney’s point tenderness and the Psoas sign), it helps to further pinpoint the location of inflammation, contributing to the diagnosis of acute appendicitis. In summary, the Obturator sign tests for pain caused by the irritation of the obturator internus muscle during hip movement, which can indicate pelvic appendicitis or other nearby inflammatory processes.