Abdominal Assessment Flashcards
On the Exam
end of bed assessment
safety
time critical
Pt general appearance
JACCO
Level of consciousness
obvious pain?
obs/vital signs
is the a temp?
Identify pain…
ask about pain…
SOCRATES
ask the Pt to point to the site of pain with 1 finger (assess that area last)
SOCRATES…
Site of the pain
Onset time
Character of the pain
Radiates
Associated symptoms
Timing
Exacerbating/relieving factors
Severity - ‘10/10’
Character of the pain…
Burning/cramping/stabbing?
What do they mean?
Types of, and referred pain…
Referred pain sites
Associated symptoms…
Weight loss
blood in the vomit or stools
haematuria
Start assessment…
Gain consent:
- if possible ask pt to empty bladder
- remember pt modesty
- set room/vehicle temp
- raise pt head to approx 30 degrees
begin a systematic approach:
- Inspect
- Auscultate
- Percuss
- Palpate
Mentally divide the abdomen into 4 quadrants…
Consider what lies beneath the surface of each quadrant…
Inspection - Hands Off!
Look for symmetry, lumps, bumps, scars, striae, colour
Look for signs of bruising:
- Cullen’s sign at the umbilicus
- Grey Turner’s sign at the flanks
Pulsating masses:
- in thin Pt you may visibly see pulsation of the Aorta
- marked pulsation may indicate AAA/Hypertension
Cullen’s Sign
Grey Turner’s Sign
Abdominal Bruising
ALthough protected beneath the bony ribcage, the spleen remains the most commonly affected organ in blunt injury to the abdomen in all age groups.
Auscultate all 4 quadrants
Auscultation…
Warm your stethoscope.
Lightly place the diaphragm slightly below and to the Right of the umbilicus in the lower Right quadrant.
Continue in a clockwise fashion in each of the 4 quadrants.
Make note of the quality and character of the bowel sounds.
Abdominal Auscultation Landmarks
Abdominal Sounds
Normal sounds are high pitched.
Normal variation between 5 to 34 sounds per minute.
Bowel sounds are classified as hypoactive, normal, or hyperactive.
Percuss…
All 4 quadrants.
Normal/Tympanic/Dull.
PN - Percussion Note.
Begin in the lower Right quadrant the proceed clockwise to cover all 4 quadrants.
Do NOT Percuss the Abdomen of…
A Pt with a suspected abdominal aortic aneurysm.
or
The abdomen of a Pt with a transplanted abdominal organ.
Palpation
Detects tenderness of organs, masses or fluid accumulation.
Light palpation is used to assess tenderness and guarding.
Deep palpation is used to assess for masses(not recommended for Paramedics)
Palpation Technique
Talk to the Pt.
Light palpation.
With fingertips make gentle rotating movements(1/2 inch/1.5 cm).
Don’t look at the abdomen, look at the Pt face guarding.
Palpate in all 4 quadrants, leaving painful areas till last.
Special Tests
Rebound Tenderness
Psoas sign
Rovsings sign
Obturator sign
Murphy’s sign
? Appendicitis
Red flags
Psoas’ sign
Rovsing’s sign
McBurney point
McBurney Point
Murphy’s Sign
Challenges
Importance of quality History.
Life threatening causes.
Women & abdominal pain.
Lots of possible causes, of which some are life threatening & time critical.
Documentation
Document all findings.
+ve & -ve are of equal value.
Can use diagrams to denote findings.
Abbreviations
RUQ - Right Upper Quadrant
LUQ - Left Upper Quadrant
LRQ - Lower Right Quadrant
LLQ - Lower Left Quadrant
BS - Bowel Sounds
PN - Percussion Note
Documenting Abbreviation example
I - no scars, bruising, masses
A - Normal BS x 4Q
P - PN normal x 4Q
P - Abdo soft, non-tender, ºrebound, ºguarding, Murphy’s -ve, Psoas -ve
Big sick vs Little sick?
Abdominal pain red flags include (but aren’t limited to)…
A concerning global overview
Systemically unwell
Rigid abdomen
Signs of dehydration
Absent/altered bowel sounds
Involuntary guarding/rebound tenderness
tenderness on percussion
