Abdominal Exam Flashcards
Grey Turner Sign
Flank ecchymosis secondary to hemorrhage
Cullen Sign
Ecchymosis around the umbilicus (periumbilical) secondary to hemorrhage
normal bowel sounds
5-35 clicks or gurgles per minute
tympany
found in the majority of the abdomen, caused by air-filled viscera
dullness
flat sound without echoes, heard over solid organs. The liver and spleen, fluid in the peritoneum or feces give a dull note
expected liver size
6-12 cm at the mid-clavicular line on the right
expected spleen size
from ribs 6-10 at the mid-axillary line on the left
abdominal examination order
inspect, auscultation, percussion, palpation
rebound tenderness
Pain upon removal of pressure, rather than the application of
pressure to the abdomen. Tests for peritoneal inflammation
guarding
Voluntary versus involuntary
rigidity
Like it sounds, abdomen is hard, involuntary reflex
rovsing’s sign
Pain in the RLQ during left-sided pressure- referred rebound tenderness seen in appendicitis
McBurney’s Point
rebound tenderness or pain 1/3 of the distance from the ASIS to the
umbilicus- may suggest appendicitis/peritoneal irritation
Murphy sign
Palpate deeply under right costal margin during inspiration, &
observe for pain &/or sudden stop in inspiratory effort. Tests for acute cholecystitis or cholelithiasis
Courvoisier’s Sign
Enlarged non-tender gallbladder secondary to pancreatic disease or cancer
esophagus sym levels
T2-8
stomach sym levels
T5-9
liver sym levels
T6-9
gallbladder sym levels
T6-9
small intestine sym levels
T9-11
colon
T10-L2
pancreas
T5-11
appendix
T12
upper portion parasympathetic levels
esophagus thru transverse colon OA, AA (vagus n.)
lower portion parasympathetic levels
descending colon, sigmoid, rectum S2-S4 (pelvic splanchnic n.)
Iliopsoas mm test
Have the patient flex their hip against your resistance- increased
abdominal pain is a positive test. This suggests irritation of the psoas muscle from
inflammation of the appendix
obturator mm test
Flex the patients right thigh at the hip, with the knee bent, and
rotate the leg internally at the hip. Right hypogastric pain is a positive test. This suggests irritation of the obturator muscle from an inflamed appendix
lloyd punch/kidney punch/costovertebral angle tenderness
gently tapping
the area of the back overlying the kidney (costovertebral angles) produces pain. This suggests an infection around the kidney (perinephric abscess) or pyelonephritis or renal stone
heel strike
Patient supine. Doc strikes patient’s heel. Pain upon striking could indicate appendicitis
