Abdominal Exam

Question 1

What is the order for abdominal exam?

Answer 1

Inspection

Auscultation

Percussion

Palpation

Question 2

What is it important to have your pt do when they lay back for the abdominal exam?

Answer 2

Bend knees

Question 3

What is diastasis recti?

Answer 3

Separation of the rectus abdominis muscles

Question 4

How do you check for diastasis recti?

Answer 4

Ask patient to lift their head off the table

Question 5

What do dilated veins on abdomen suggest?

Answer 5

Portal hypertension due to cirrhosis

Question 6

When do you see increased peristaltic waves

Answer 6

Intestinal obstruction

Question 7

What can cause ecchymosis on abdomen

Answer 7

Hemorrhage in abdomen

Question 8

What can cause high-pitched tinkling bowel sounds

Answer 8

Early Intestinal obstruction

Everything proximal to obstructing will be dilated

Question 9

What percussion sound will predominate in abdomen/

Answer 9

Tympany due to gas in GI tract

Question 10

What does this suggest:

Distended abdomen that is tympanic throughout

Answer 10

Intestinal obstruction

Paralytic ileus

Question 11

Protuberant abdomen with bulging flanks and dullness suggests:

Answer 11

Ascites

Question 12

Where should the vertical span of the liver be measured?

Answer 12

Mid clavicular line

Question 13

What is the normal liver size at MCL?

Answer 13

6-12 cm

Question 14

What direction does the spleen expand in?

Answer 14

Anteriorly, downward, and medially

Question 15

What are two types of muscular resistance?

Answer 15

Guarding

Rigidity

Question 16

What do peritoneal signs suggest?

Answer 16

Intrapertoneal infection, ruptured viscus, etc

Question 17

What is guarding/tensing?

Answer 17

Voluntary contraction of abdominal muscles with palpation

(May diminish when pt is distracetd_

Question 18

What is rigidity/stiffness?

Answer 18

Involuntary reflex contraction of abdominal muscles with palpation

Question 19

Where do liver and gallbladder pain refer to?

Answer 19

R shoulder

Question 20

Where does appendix pain refer to?

Answer 20

Periumbilicus area

Question 21

What exam findings would you expect for acute cholesyctitis?

Answer 21

RUQ pain

+Murphy’s sign

Question 22

What exam findings would you expect with acute pancreatitis?

Answer 22

Epigastric pain that may radiate to the back

Question 23

What exam findings would you expect wirth acute appendicitis?

Answer 23

Pain begins at umbilicus

Migrates to RLQ*

+Psoas, Obturator, Rovsing’s signs

Question 24

What exam findings would suggest acute diverticulitis?

Answer 24

LLQ pain

Question 25

What exam findings would you expect with acute pyelonephritis?

Answer 25

+costovertebral angle tenderness

Question 26

What must pt do when you palpate their liver?

Answer 26

Take a deep breath

Question 27

What must pt do for you to palpate the spleen?

Answer 27

Take a deep breath

Question 28

What can cause splenomegaly?

Answer 28

Congestive diseases (portal HTN, heart failure, etc) Hematologist malignancies Mononucleosis Bacterial/parasitic infections

Question 29

What can cause kidney enlargement?

Answer 29

Hydronephrosis Cysts/tumors Polycystic Kidney Disease

Question 30

What are abnormal findings with liver palpation?

Answer 30

Firmness Bluntness/rounding of edge Surface irregularities

Question 31

What are the three peritoneal signs?

Answer 31

Guarding Rigidity Rebound tenderness ********

Question 32

WWhat does a positive rebound tenderness in RLQ suggest?

Answer 32

Appendicitis

Question 33

What is the Rovsing’s sign? | Normal

Answer 33

Press gently and deeply in LLQ and look for pain in RLQ

Question 34

What is the variation of Rovsing’s sign aka referred rebound tenderness?

Answer 34

Press gently and deeply in LLQ and QUICKLY withdraw fingers, looking for pain in RLQ

Question 35

What are the 2 wats to do psoas sign?

Answer 35

1. Resisted straight leg raise | 2. While lying on L side, extend pt’s R leg @ hip

Question 36

What is a positive psoas sign?

Answer 36

RLQ pain suggests inflamed appendix

Question 37

What is obturator sign?

Answer 37

With pt supine, flex R leg at hip, bend the knee, and then rotate leg internally @ hip

Question 38

What is a positive obturator sign?

Answer 38

RLQ pain may indicate inflamed appendix

Question 39

What is the shifting dullness technique?

Answer 39

Supine: find border of tympany and dullness THen roll on side and see if it moved

Question 40

What does a positive shifting dullness test suggests/.

Answer 40

Ascites

Question 41

What is the fluid wave technique?

Answer 41

Stabilize mid-abdomen and tap one side and see if a fluid wave hits your hand on the other side

Question 42

How is Murphy’s sign tested?

Answer 42

With your fingers under the right ribs, ask patient to take a deep breath and look for a SUDDEN stop in inspiratory effort

Question 43

What does a positive Murphy’s sign suggest?

Answer 43

Acute cholecystitis

Question 44

Psoas, Obturator, and Rovsing’s are helpful in the assessment of peritoneal irritation, which can be associated with:

Answer 44

Appendiceal inflammation

Question 45

Shifting dullness and fluid wave are helpful in the assesssment of:

Answer 45

Ascites

Question 46

Sudden pain the RUQ during inspiration constitutes a positive:

Answer 46

Murphy’s sign

Question 47

Ventral hernias can be identified by asking the pt to:

Answer 47

Raise head and shoulders off the table