Abdominal assessment

Question 1

What is the acronym for the abdominal assessment?

Answer 1

Inspect
Auscultate
Percussion
Palpation

Question 2

What should we generally inspect before/during the abdominal assessment?

Answer 2

Hands, arms, axilla, face

Question 3

What is the Cullen’s sign?

Answer 3

Bruising surrounding umbilicus - suggests pancreatitis/ruptured AAA

Question 4

What is the Grey-Turner’s sign?

Answer 4

Bruising in the flanks - suggests pancreatitis/ruptured AAA

Question 5

What does abdominal distension indicate?

Answer 5

fluid/fat/constipation/fetus

Question 6

What is striae?

Answer 6

reddish/pink (new) or white/silverish (chronic) abdominal distension

Question 7

What is caput medusae?

Answer 7

engorged paraumbilical veins - portal hypertension

Question 8

What are the different stomas

Answer 8

Colostomy, ileostomy, urostomy

Question 9

What are we looking for on inspection?

Answer 9

Pallor, mottling, jaundice, bruising, swelling, masses, pulsations, scars, visible peristalsis, implanted devices , rashes, hernias

Question 10

What are the causes of generalised distension?

Answer 10

Fat, fluid, flatus, faeces, foetus

Question 11

What is the fluid waveband shifting dullness?

Answer 11

Tests used to differentiate between gas and fluid in a distended abdomen

Question 12

How do you perform the fluid wave?

Answer 12

Stand on the right, and place the ulna edge of your patients hand along the midline of the abdomen
Next place your hands on the right and left flanks
With your right give the abdomen a firm strike, if large amounts of fluid are present a wave will travel across the abdo and you will feel a distinct tap on the left hand. If the distension is due to gas or adipose tissue you will feel no change

Question 13

How do you perform the shifting dullness test?

Answer 13

Lie your patient supine and wait for gravity to shift fluid to the most dependant parts
Next percuss down the abdo from the umbilicus to the right flank, when tympany changes to a dull note, mark this spot.
Now roll your patient onto their right side, wait a short while again and repeat percussion from the umbilicus down the right flank.
This time if over 500mls of fluid is present the dull note (mark) will be higher up closer to umbilicus.

Question 14

What is ascites?

Answer 14

when fluid builds up in the stomach

Question 15

What is ascites associated with?

Answer 15

heart failure, portal hypertension, cirrhosis, Hepatitis, prancreatitis and cancer

Question 16

What is Murphy’s sign?

Answer 16

a test which assesses for cholecystitis

Question 17

How do you perform the Murphy’s sign?

Answer 17

hook fingers under the liver and ask pt to take a deep breath - positive if the patient halts due to pain on inhalation

Question 18

What is Rovsing’s sign

Answer 18

a test for appendicitis

Question 19

How do you perform the Rovsing’s sign?

Answer 19

press deeply on the left lower quadrant, if pain felt on right lower quadrant then its a positive sign

Question 20

How do you find the McBurney’s point?

Answer 20

Right hand, little finger on umbilicus, where index finger points is the McBurney’s point

Question 21

How do we test for the Psoas sign?

Answer 21

Lie pt on left hand side and gently flex and extend their right leg - this will cause the psoas muscle and cause pain if it rubs against the inflamed appendix