Abdominal Exam Flashcards
Inspection
- General appearance
- Vital signs
- Scleral icterus
- Skin tugor
- Venous pattern - caput medusae
- Skin characteristics
- Contour ( protuberant, flat, scaphoid)
- Symmetry
- Surface motion
- Musculature
Patient position for an abdominal exam
- Comfortable
- Supine, with knees slightly flexed and neck in a neutral position
Skin signs:
-abnormal color
-jaundice, cyanosis
-bruises, erythema
-periumbilical discoloration
(Cullen’s sign- acute pancreatitis)
-Flank discoloration
(Grey Turner sign- ac. pancreatitis)
-Striae- purple stretch marks- cushings
-Scars
(Draw- location, size, condition)
Ask about & consider adhesions
Look for these bulges with Pts head lifted:
- Hernias: umbilical, incisional,
epigastric - Diastasis recti ( 2 recti from split)
- Lipomas (benign fat tumor)
Diaphragm:
^ pressure engages it
^ pitch can be heard
- bowel sounds in all 4 quads
- friction rub over liver and spleen
Bell:
Low pressure
Decreased pitch can be hers
-> Venous hums
- Epigastrium
- Umbilicus
-> Bruits
- Aorta
- Renals
- Iliacs
- FemoralsHigh pitch tinkling bs :
= obstruction
If ten situ of abdomen remains after advising the pt to relax on palpating:
Involuntary board like hardness=
Peritoneal irritation
Peritoneal irritation
Primary
- cirrhosis -> ascites
Secondary
- pancreatitis -> pancreatic enzymes
- gall bladder-> bile
- stomach perf. -> acid
- tubal preg. rupture -> blood
Peritoneal inflammation Sx:
- localized pain
- rebound tenderness
Liver border by costal margin > 2-3cm:
Hepatomegly
Or
Displacement from lung dz
Avg liver span
6-12 cms
Liver movement with inspiration
Descend
Murphy’s sign:
Gallbladder inflammation
- PT take a deep breath in and observe for cessation of inspiration as the pressure you apply continues
Don’t forget to palpate the: and measure it:
Aorta - should be 50yo
Check for palpable ____.
Bladder
Summery of abdominal exam:
-Inspection
-general
-abdomen
-Auscultation
-bowl sounds
-vasculature ( venous hums, Bruits,
friction rub)
-Percussion
-general
-liver
-spleen
-Palpation
-general
-liver
-spleen
-CVA tenderness
Pelvic/ Rectal
Ascities Tests
Fluid wave ( tap)
Shifting dullness ( percussion /
decubital position)Ballance’s sign:
Rare hematuria from splenic rupture causing :
Left- dull flank from Coag. Blood
Right- shifting dullness from liquid blood
Courvoisier’s sign:
Jaundice with palpable gallbladder
- if non tender more likely to be pancreatic mass
Fothergill’s sign
Rectus sheath hemotoma
- superficial abdominal mass
- does not cross midline
- stays the same while lifting head***
Carnett’s sign:
Cavity mass non-palpable + deminished
Dance sign:
Seen with intusseption -
Empty RLQ but sausage mass RUQ
Charcot’s Triad:
- jaundice
- fever
- RUQ pain
Boas’ sign:
Hyperaesthesias below the right scapula
( help diff from musculoskeletal pain)
Appendicitis tests:
- Iliopsoas sign
- Obturator sign
- Markle sign
- Rovsing’s sign
- Aaron’s sign over McBurney’s point
Rovsing’s sign
- sign of appendicitis
- RLQ pain when LLQ palpated
Markle sign
Heel jar
Aaron’s sign
Appendicitis sign
Pain in Epigastrium when holding palpation over McBurney’s point
Iliospoas sign
Appendicitis sign
Attempt hip flexion with exonerated resistance
(+) pain in RLQ
Obturator sign
Same as psoas appendicitis
- internal and external hip rotation with knee at 90*
(+) suprapubic area pain
Cholecystitis signs
- Murphy’s sign
- Boas’ sign
Peritoneal irritation:
- Rebound tenderness (Blumberg sign)
- Invol. Guarding
Castell’s sign
Splenic percussion sign
Reynold’s Pentad:
** medical emergency**
Charcot’s triad
- jaundice
- fever
- RUQ pain
Plus/
- HYPOtension
- mental status changes
