Abdominal Exam Flashcards
Steps of abdominal exam
- Inspection
- Auscultation
- Percussion
- Palpation
What are aspects of your inspection exam of the abdomen?
Skin color/characteristics
Contour/symmetry
Surface motion
Pulsations
What types of skin changes/characteristics are you looking for on your inspection exam of abdomen
Jaundice Grey turner sign Cullen sign Scars/striae Dilated veins Rashes and lesions
What aspects of contour/symmetry are you looking for on inspection of abdomen
Abdominal distension
Hernias/masses
What are you looking at with surface motion of inspection of abdomen
Peristalsis
Flank ecchymosis secondary to hemorrhage
Grey Turner Sign
Ecchymosis around the umbilicus (periumbilical) secondary to hemorrhage
Cullen sign
Auscultation of abdomen
Bowel sounds: Note the frequency and character of bowel sounds with diaphragm of stethoscope. Listen in all 4 quadrants
Vascular sounds: abdominal aorta, iliac, renal, and femoral aa. — listen for bruits with bell of stethoscope
Normal bowel sounds
5-34 clicks or gurgles per minute
Abnormal bowel sounds
High pitched, decreased/absent
Percussion of abdomen assesses for ____ and _____
Tympany; dullness
Describe tympany found on abdominal percussion
Found within majority of abdomen, caused by air filled viscera
Describe dullness found on abdominal percussion
Flat sound without echoes, heard over solid organs. The liver and spleen, fluid in peritoneum, or feces give dull note
Expected liver span
6-12 cm at midclavicular line on right
Expected spleen span
From ribs 6-10 at midaxillary line on left
Levels of palpation
Light = up to 1 cm depth in all 4 quadrants
Moderate = 2-3 cm depth in all 4 quadrants
Deep = more than 3 cm in all 4 quadrants
Pain upon removal of pressure
Rebound tenderness
What does rebound tenderness indicate
Peritoneal inflammation
Voluntary tightening of abdominal mm secondary to pain
Guarding
Abdomen is hard, involuntary reflex contraction of abdominal wall
Rigidity
What is significance of McBurney’s point
Rebound tenderness or pain 1/3 of distance between ASIS and umbilicus — indicates possible appendicitis/peritoneal irritation
What is Rosving’s sign
Pain in RLQ during left-sided pressure — indicates possible appendicitis (referred rebound tenderness)
Iliopsoas muscle test
Have pt flex their hip against resistance.
+ test = Increased abdominal pain
Indicates irritation of the psoas muscle from inflammation of the appendix
Obturator m. Test
Flex pt’s right thigh at hip, with the knee bent, and rotate the leg internally at the hip.
+ test = right hypogastric pain
Indicates irritation of the obturator muscle from inflammation of the appendix
Heel strike
With patient supine, strike patient’s heel
+ test = abdominal pain
Indicates possible appendicitis or peritonitis
Liver palpation
Left hand behind patient’s back, supporting right 11th and 12th ribs, and lightly press anterior
Right hand just below costal margin in midclavicular line with fingers pointing cephalad or in oblique position. Gently press in and up with fingertips, try to palpate liver edge during patient’s inhalation
[also alternate hooking technique]
Murphy’s sign
Palpate deeply under right costal margin during inspiration
+ test = pain and/or sudden stop in inspiratory effort
Indicates acute cholecystitis or cholelithiasis
Courvoisier’s sign
Enlarged nontender gallbladder
Indicates pancreatic disease/cancer
T/F: the normal spleen should be palpable
False, should not be palpable
Lloyd punch
Gently tap area of the back overlying the kidney (CVAs)
+ test = pain
Indicates infection around kidney (perinephric abscess), pyelonephritis, or renal stone
Expected width of aorta
2-3 cm with pulsation in anterior-inferior direction
[unexpected would be greater than 3 cm in width with prominent lateral pulsation]
2 major structures in RUQ
Liver
Gallbladder
3 major structures in RLQ
Appendix
Cecum
Ovary
2 major structures in LLQ
Sigmoid colon
Ovary
Major structure in LUQ
Spleen
Of the 9 regions of the abdomen, what are the columns on each side from top to bottom?
Right/Left Hypochondriac region
Right/Left Lumbar region
Right/Left Iliac region
In the 9 regions of the abdomen, what is the center column from top to bottom?
Epigastric region
Umbilical region
Hypogastric region
Cullen’s sign consists of ecchymosis around the umbilicus, also known as ____; this is the same as Grey-Turner’s sign, but that is ecchymosis of the ____
Hemoperitoneum; flanks
Signs of liver failure on abdominal exam
Jaundice Ascites Caput medusae (portal HTN) Hepatomegaly Fluid wave on percussion
What might cause absence of bowel sounds
Long lasting intestinal obstruction
Intestinal perforation
Mesenteric ischemia
What might cause decreased bowel sounds? (None for 1 min)
Post-surgical ileus
Peritonitis
What might cause increased bowel sounds?
Diarrhea
Early bowel obstruction
What might cause high pitched bowel sounds
Early intestinal obstruction
What might cause bruits heard in abdominal exam?
Vascular obstruction
What might cause friction rub on abdomen auscultation
Inflammation of peritoneal surface of an organ (liver or spleen)
What might cause venous hum on auscultation of abdomen
Increased collateral circulation between portal and systemic venous systems (heard over epigastric and umbilical region)
Protruberant abdomen tympanitic throughout may indicate what
Intestinal obstruction
During palpation of a tender abdomen, what is an important consideration?
Warm hands and palpate tender area LAST
Difference between parietal and visceral abdominal pain
Parietal occurs d/t inflammation in parietal peritoneum, more easily localized, steady, and aggravated by movement or coughing, pt wants to lie still
Visceral abdominal pain occurs when organs contract or are distended, or from ischemia causing stim of visceral pain fibers, usually difficult to localize and palpated at midline of structure involved
Examples of visceral pain
Liver distention against its capsule with alcoholic hepatitis (RUQ)
Periumbilical visceral pain = acute appendicitis
Examples of parietal pain
Acute cholecystitis (RUQ/epigastric)
Acute pancreatitis (epigastric)
Late appendicitis (RLQ)
Acute diverticulitis (LLQ)
Examples of conditions causing referred abd. pain
Duodenal and pancreatic pain classically referred to back
Biliary tree referred to right shoulder — diaphragm irritation
What increases vertical span of liver
Enlargement d/t cirrhosis, lymphoma, hepatitis, right-heart failure, amyloidosis, hemachromatosis
Right pleural effusion (falsely increased)
What decreases the vertical span of the liver
Shrunken liver = cirrhosis
Free air under diaphragm/perforated hollow viscus
The liver span is _____ in the midsternal line and _____ cm in the midclavicular line
4-8 cm; 6-12
Irregular edge or nodules on liver exam may indicate what
Hepatocellular carcinoma
Firmness/hardness on liver exam may indicate what
Cirrhosis, hemachromatosis, amyloidosis, lymphoma
Dullness at the midaxillary line on spleen percussion would indicate what
Splenomegaly
Splenomegaly may be present in what conditions
Portal HTN Blood malignancies HIV Splenic infarct Hematoma Mono
Tests for ascites
Shifting dullness test — percuss borders of tympany and dullness with pt supine vs. lateral recumbent; if borders change, positive test
Test for fluid wave — postive test if impulse transmitted to other flank
4 tests for appendicitis
McBurney’s point
Rosving’s sign
Psoas sign
Obturator sign
Test for cholecystitis
Murphy’s sign
Testing for ventral hernia
When lying supine, have pt raise head and shoulders off table, positive test is bulge of hernia
