Abdominal Exam Flashcards
Most common abdominal symptoms
Pain
Alteration of bowel habits (constipation, diarrhea)
Indigestion/heartburn
Symptom characterization for bowel habits
Diarrhea: # of stools per day, loose or watery, blood or mucus or none, color
Constipation: Frequency of BM, straining, blood
Symptom characterization for abdominal pain
- Onset
- Provocation
- Palliation
- Quality
- Region
- Radiation
- Severity
- Timing
- Associated symptoms
Symptom characterization for bloody stool
- Volume of blood
- Rapidity of bleeding (frequency and # of events)
- Color
- Location (see location card)
Location of GI Bleeding
Appendicitis symptom constellation
mild crampy peri-umbilical pain becoming steady more severe and
localizing to RLQ, anorexia, n/v
Cholecystitis symptom constellation
episodic “attacks”, right upper abdomen,
radiates to right scapula or shoulder
Abdominal contour
Observation of the abdominal surface
For the abdomen, always do ___ before ___.
For the abdomen, always do auscultation before palpation.
Palpation may induce bowel sounds when there are none at rest.
Auscultation of the abdomen
Location of important abdominal vasculature
Percussion of the abdomen
Percussing the liver
Percussing the spleen
Traube’s space
Area bounded by left sixth rib superiorly, left anterior axillary line laterally and left costal margin inferiorly
Palpation of the abdomen
Light palpation
Deep palpation
Palpating the liver
- Left hand behind patient (~11th or 12th ribs) on right side and press forward
- Right hand on patient’s abdomen lateral to rectus
- Fingertips well below lower border of dullness
- Press up and in as you ask patient to take deep breath. If palpable liver edge will move down and touch fingertips
- Normal liver edge-soft, smooth and with inspiration palpable ~ 3cm below RCM in MCL
“Hooking technique” for liver palpation
Palpating the spleen
- Left hand reaches around patient to support and press forward on left lower rib cage
- Right hand below LCM presses in toward spleen
- Start low (well below a possibly enlarged spleen!)
- Ask patient to take deep breath
- If palpable spleen tip will move down and tap fingertips
- Normal spleen is not palpable
- Repeat with patient on RIGHT side-gravity brings spleen forward and to the right
Palpation of the aorta
Example of normal abdominal exam report
Example of abnormal abdominal exam report
