Abdominal Exam Flashcards
1
Q
How should the patient best position themselves for an abdominal assessment?
A
Lying flat
If the patient struggles with their legs being flat they can bend them
2
Q
Why should the patient lie flat for an abdominal assessment?
A
Abdominal muscles are relaxed
3
Q
What should you be mindful to ensure you are observing for throughout the entirety of an abdominal exam?
A
Any signs of pain or distress
If any part of the assessment is causing the patient pain or discomfort
4
Q
How would you best wish the patient to be exposed for an abdominal exam?
A
Exposed from nipples to knees - allowing for a full view of the abdomen
However, the absence of a shirt will usually be sufficient
5
Q
What could abdominal distention indicate?
A
Fluid
Faeces
Flatus
Fat
Foetus
Tumour
6
Q
You note asymmetry of the contours of the abdomen, what could this indicate?
A
Organomegaly
Massess
Fluid
7
Q
What is organomegaly?
A
general term for the enlargement of an organ
8
Q
Why should you check for any scars on the patients abdomen?
A
Scars can indicate any previous pathology requiring surgery
9
Q
What is Cullens sign?
A
superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region
10
Q
What is Grey Turners sign?
A
Bruising evident on the flanks - between the last rib and the top of the hip
11
Q
What can be observed in this photo?
A
Cullens sign - Bruising evident around the umbilical region
12
Q
What can be observed in this photo?
A
Grey Turners sign - Bruising evident on the flanks
13
Q
What are Cullens sign and Grey Turners sign both indicative of?
A
Pancreatitis
14
Q
What can be observed in this photo?
A
Spider naevi
15
Q
What are spider naevi?
A
Visible blood vessels underneath the skin
16
Q
What do spider naevi often indicate?
A
Underlying disease, particularly alcoholic cirrhosis of the liver
17
Q
Why are spider naevi sometimes observed in pregnant women?
A
In response to pharmacological agents often given in pregnancy
18
Q
Caput medusae?
A
Due to portal hypertension
presents as a cluster of swollen veins in the abdomen, often concentrated around the belly button.
Increased pressure in portal vein caused by blood trying to get to the liver
19
Q
Common cause of caput medusae?
A
The umbilical veins carry the blood to the heart but the increased pressure causes umbilical veins to become distended – liver cirrhosis
20
Q
What can be observed in this photo?
A
Caput Medusae
21
Q
When are stretch marks often observed?
A
Pregnancy and rapid weight gain
22
Q
What can abnormal hair distribution be a sign of?
A
Endocrine problems
In females - polycystic ovarian syndrome (PCOS)
23
Q
Where in the abdomen would you observe for pulsation?
A
Above the umbilical region from sideways on
24
Q
When might you observe slight pulsation in the umbilical region?
A
Very thin people
25
What is a large visible pulsation in the umbilical region a sign of?
Abdominal aortic aneurysm (AAA)
26
What is a hernia?
occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall
27
Where are hernias most commonly seen?
Epigastric
Umbilical
Femoral (in females)
Inguinal (in males)
28
How do you assess a patient for hernias?
Firstly look with the patient lying down
Then ask the patient to stand up and cough
If a hernia is seen, attempt to push it back in, if there is pain or it will not go back in when pushed, the patient should be referred for investigation
29
Why do you ask the patient to cough when assessing for hernias?
Coughing helps exaggerate any hernias if present
30
Name abdominal region 1
Right hypochondriac
31
Name abdominal region 2
Epigastric region
32
Name abdominal region 3
Left hypochondriac
33
Name abdominal region 4
Right Lumbar
34
Name abdominal region 5
Umbilical region
35
Name abdominal region 6
Left Lumbar
36
Name abdominal region 7
Right Iliac
37
Name abdominal region 8
Hypogastric region
38
Name abdominal region 9
Left Iliac
39
What organs are situated in the right hypochondriac?
Larger lobe of liver
Gallbladder
Right kidney
Small intestine
40
What organs are situated in the epigastric region?
Stomach
Smaller lobe of liver
Pancreas
Spleen
Duodenum (first part of small intestine)
Adrenal glands
41
What organs are situated in the left hypochondriac?
Spleen
Colon (large intestine)
Left kidney
Pancreas
42
What organs are situated in the right lumbar?
Base of liver
Right colon
43
What organs are situated in the umbilical region?
Umbilicus (navel)
Parts of the small intestine
44
What organs are situated in the left lumbar?
Descending colon (large intestine)
45
What organs are situated in the right iliac?
Appendix
Cecum
46
What organs are situated in the hypogastric region?
Urinary bladder
Sigmoid colon (large intestine)
Female reproductive organs
47
What organs are situated in the left iliac?
Descending colon (large intestine)
Sigmoid colon (large intestine)
48
Before palpating the abdomen, what should you first do?
Auscultate for bowel sounds
49
Why should you auscultate before palpating the abdomen?
Palpation of the abdomen can alter bowel sounds
50
Which side of your stethoscope should you use when auscultating the abdomen?
The diaphragm - picks up higher pitched bowel sounds
51
What is classed as 'normal' bowel sounds?
Irregular gurgling sounds
Frequency of 5-30 in a minute
52
If you hear over 30 bowel sounds in a minute what is this a sign of?
Hyperactive bowel - such as in diarrhoea
53
If you hear less than 5 bowel sounds in a minute what is this a sign of?
Underactive bowel - such as in constipation
54
What do absent bowel sounds indicate?
A possible bowel obstruction
55
When auscultating the abdomen you hear tinkling sounds, what can this indicate?
Early bowel obstruction.
56
How long should you ideally listen to bowel sounds in each quadrant?
1 minute
57
Where should you first auscultate the abdomen?
Right of the umbilicus
Move around the quadrants starting in the LRQ
58
Name quadrant A
Right upper quadrant (RUQ)
59
Name quadrant B
Left upper quadrant (LUQ)
60
Name quadrant C
Lower right quadrant (LRQ)
61
Name quadrant D
Lower left quadrant (LLQ)
62
Aside from auscultating for bowel sounds, what should you also auscultate for?
Bruits of the aorta, renal and iliac arteries
63
What is bruits, what causes it and what does it sound like?
abnormal sounds described as whooshing noises due to turbulent blood flow caused by atherosclerosis
64
How should you auscultates the aorta, renal and iliac arteries for bruits?
with the bell of your stethoscope - best at picking up low pitched sounds
65
How do you auscultate the aorta, renal and iliac arteries for bruits?
Firstly listen to the aorta
Then the renal arteries
Lastly the iliac arteries
66
Where would you best auscultate the aorta?
Just above the umbilicus
67
Where would you best auscultate the renal arteries?
2cm above the umbilicus and 2cm horizontally either side
68
Where would you best auscultate the iliac arteries?
2cm down from the umbilicus and 2cm horizontally either side
69
What would you expect to hear when auscultating for bruits in a healthy individual?
Nothing
70
Before palpating the patients abdomen, what must you first check?
If they have any pain
71
If a patient is complaining of pain in their right upper quadrant, what organs could this indicate an issue with ?
Underlying organs such as the liver; right kidney or gall bladder
72
If a patient is complaining of pain in their left upper quadrant, what organs could this indicate an issue with ?
Pancreas, spleen, left kidney
73
If a patient is complaining of pain in their lower left quadrant, what organs could this indicate an issue with ?
Descending colon
74
If a patient is complaining of pain in their lower right quadrant, what organs could this indicate an issue with ?
Ascending colon
Appendix
75
After palpating lightly in all 4 quadrants what should you do?
Palpate deeply
Test for guarding
76
What organs would you palpate in the right upper quadrant?
Liver
Gallbladder
77
What organs would you palpate in the left upper quadrant?
Transverse colon
Spleen
Pancreas
78
What organs would you palpate in the lower left quadrant?
sigmoid colon
descending colon
79
What organs would you palpate in the lower right quadrant?
appendix
80
What organs would you palpate in the hypogastric region?
Urinary bladder
81
What is guarding?
Guarding is the voluntary contraction of the abdominal muscles over inflamed organs or tissues below - to protect from pain
82
When would you most likely observe guarding?
Localised inflammation of an organ - for example in peritonitis or appendicitis
83
Why does guarding make abdominal assessments harder to conduct?
Often unable to feel organs below
Unable to palpate deeply due to patient discomfort
84
What is rigidity?
Involuntary muscle spasm due to generalised hardness and inflammation of the abdomen
Often global
85
When would you most expect to observe rigidity?
Peritonitis
86
When would you most likely expect to observe rebound tenderness?
Appendicitis
Peritonitis
87
What is McBurney's point?
McBurney's point refers to the point on the lower right quadrant of the abdomen at which tenderness is maximal in cases of acute appendicitis
88
Where is McBurney's point?
The line between the umbilicus and the iliac crest, moving 1/3 of the way up from iliac crest
89
If rebound tenderness is observed on palpation of McBurney's point, what is this indicative of?
Appendicitis
90
Explain Rosvings sign.
Palpate the lower left quadrant of the abdomen - If referred pain is experienced on the lower right quadrant this is indicative of appendicitis
91
What condition is rebound tenderness also common in aside from appendicitis?
Peritonitis
92
How do you test for rebound tenderness?
Palpate an area of the abdomen deeply and release quickly - if pain is experienced when the hand is removed, this is known as rebound tenderness
93
What is ascites?
Excess fluid in the abdomen
94
What condition is often the cause of ascites?
Liver failure
95
How would you percuss for the presence of ascites?
Percuss in a straight line from the umbilicus to the flank
You should hear tympany/hyper-resonance - if you hear any dullness, mark with tape for later reference
96
What does hyper-resonance/tympany on percussion indicate?
hollow, high, drumlike sounds that indicate the presence of air/gas
97
If dullness has been observed on percussion of the abdomen, which further 2 tests can you perform to confirm the presence of fluid in the abdomen?
The shifting dullness test - After determining an area of dullness in the abdomen, the patient is asked to roll onto the side of dullness, facing away from the examiner
Wait 30 seconds
Percussion from umbilicus to flank is repeated
A positive test: the area of dullness will shift to the dependent site and the area of tympany will shift towards the top
Fluid wave test - Ask the patient to place the ulnar aspect of their hand vertically above the umbilicus and push down
The examiner then taps one flank, while feeling on the other flank for the tap.
The result is considered positive if tap can be felt on the other side.
98
Why must a hand be placed in the centre of the abdomen during the fluid wave test?
The pressure on the midline prevents vibrations through the abdominal wall and prevents a false positive from the movement of tissue
99
Can the spleen often be palpated?
No
In a healthy individual the spleen will not be palpable
100
If the spleen is palpable, what is this called?
splenomegaly (enlarged spleen)
101
If the spleen is palpable, what is the common cause?
Glandular fever
Trauma
102
How do you palpate the spleen?
Stand on the right side of the patient, place your left hand under the LS ribcage to support the abdomen
Start at the umbilicus, move up towards the left upper quadrant palpating for the splenic edge by pushing down and up
103
Where do the kidneys sit?
Mostly under the ribs on both sides
104
How do you palpate the kidneys?
Normally unable to palpate
Bi-manual technique (2 handed).
Left hand behind pt just below 12th rib and in the costovertebral angle, lift left kidney upwards and place right hand in right upper quadrant to try to capture the kidney between both hands.
Ask pt to breathe in as palpating.
Repeat for right kidney, left hand underneath with right hand on top.
105
When palpating the kidneys what are you observing for?
Any tenderness or inflammation
106
What could tenderness or inflammation during palpation of the kidneys indicate?
pyelonephritis
107
What is pyelonephritis?
Pyelonephritis is the infection of one or both of the kidneys
108
What are the most common causes of pyelonephritis?
Untreated UTIs / infections of the bladder leading to the infection of the kidney(s)
Kidney stones
109
When palpating the liver, what should you feel?
Often not palpable, but if it is it should be smooth and anglular
110
What is the costal margin?
lower margin of the thoracic wall (bottom of the ribcage)
111
How do you palpate the liver?
Start by placing fingers in right iliac
Ask patient to breathe in and out, during the expiratory phase, move your fingers into position & during inspiration push inwards, trying to feel the liver edge.
With every breath gradually work your way up to the patient’s right costal margin.
Feel for the edge of the liver hitting your fingers
112
What might you feel on palpation of the liver that could indicate cirrhosis?
Wobbly surface - usually the liver should feel smooth and angular
113
If the liver is felt to be protruding below the ribs what could this indicate?
hepatomegaly
(hep-uh-toe-MEG-uh-le)
114
What is hepatomegaly?
The enlargement of the liver
115
In what condition is enlargement of the liver often seen?
Hepatitis
116
How would you test for Murphy's sign?
Place left hand flat under patients right costal margin (rib cage) 2-3cm from midline
Ask the patient to take a deep breath in, as they breathe out push your hand up under their ribcage
If the patient experiences immediate pain when their gallbladder hits your fingers - this is a positive test
117
What does a positive Murphy's test indicate?
Cholecystitis
118
When is cholecystitis most prevalent?
Heavy drinkers
5 F's - female, forties, fair, fat, fertile
119
Why would you percuss the liver?
To assess the size
120
How would you percuss the liver?
Percuss downwards along the right mid-clavicular line from the top of the chest
Mark where the sound changes from norm-resonant to dull
Then starting at the bottom of the abdomen, percuss upwards until the sound changes from tympany to dull and again mark with tape
Measure the distance between the tape marks
Normal is between 6-12cm
121
After percussing the liver you measure more than 12cm, what could this indicate?
hepatomegaly - an enlarged liver
exampled in liver disease
122
When percussing all 4 quadrants of the abdomen what would you expect to hear?
Tympany / hyper-resonance
Unless directly over an organ/structure, where you would expect to hear hypo-resonance
123
When percussing the abdomen, you note hypo-resonance, what could this indicate?
Indicate an underlying organ, solid or fluid
124
What does DRE stand for?
Digital Rectal Exam
125
What exam SHOULD be included in a full abdominal assessment but should NOT be performed in an OSCE?
Digital Rectal Exam
126
Why should a DRE not be performed in the OSCE?
It is not appropriate or necessary in the situation
127
What omission should you ensure you note on any paperwork after stating a full abdominal exam has been performed, why?
A digital rectal exam (DRE) has not been performed - so it is not assumed it has been completed and therefore no adverse findings
128
How would you perform a DRE?
Ask the patient if they want a chaperone present
Get the patient to lay in the left lateral position with their knees tucked up to their chest
Using a gloved and lubricated index finger, insert it into the rectum feeling all 4 quadrants
129
What are you observing for in a DRE?
Pain
Bleeding
Faeces
Prostrate (men)
Cervix (female)
130
What is the costal margin?
lower margin of the thoracic wall (bottom of the ribcage)
131
What can be observed in this photo?
Caput Medusae
