Abdominal Exam Flashcards
What is the order for abdominal exam?
Inspection
Auscultation
Percussion
Palpation
What is it important to have your pt do when they lay back for the abdominal exam?
Bend knees
What is diastasis recti?
Separation of the rectus abdominis muscles
How do you check for diastasis recti?
Ask patient to lift their head off the table
What do dilated veins on abdomen suggest?
Portal hypertension due to cirrhosis
When do you see increased peristaltic waves
Intestinal obstruction
What can cause ecchymosis on abdomen
Hemorrhage in abdomen
What can cause high-pitched tinkling bowel sounds
Early Intestinal obstruction
Everything proximal to obstructing will be dilated
What percussion sound will predominate in abdomen/
Tympany due to gas in GI tract
What does this suggest:
Distended abdomen that is tympanic throughout
Intestinal obstruction
Paralytic ileus
Protuberant abdomen with bulging flanks and dullness suggests:
Ascites
Where should the vertical span of the liver be measured?
Mid clavicular line
What is the normal liver size at MCL?
6-12 cm
What direction does the spleen expand in?
Anteriorly, downward, and medially
What are two types of muscular resistance?
Guarding
Rigidity
What do peritoneal signs suggest?
Intrapertoneal infection, ruptured viscus, etc
What is guarding/tensing?
Voluntary contraction of abdominal muscles with palpation
(May diminish when pt is distracetd_
What is rigidity/stiffness?
Involuntary reflex contraction of abdominal muscles with palpation
Where do liver and gallbladder pain refer to?
R shoulder
Where does appendix pain refer to?
Periumbilicus area
What exam findings would you expect for acute cholesyctitis?
RUQ pain
+Murphy’s sign
What exam findings would you expect with acute pancreatitis?
Epigastric pain that may radiate to the back
What exam findings would you expect wirth acute appendicitis?
Pain begins at umbilicus
Migrates to RLQ*
+Psoas, Obturator, Rovsing’s signs
What exam findings would suggest acute diverticulitis?
LLQ pain
What exam findings would you expect with acute pyelonephritis?
+costovertebral angle tenderness
What must pt do when you palpate their liver?
Take a deep breath
What must pt do for you to palpate the spleen?
Take a deep breath
What can cause splenomegaly?
Congestive diseases (portal HTN, heart failure, etc)
Hematologist malignancies
Mononucleosis
Bacterial/parasitic infections
What can cause kidney enlargement?
Hydronephrosis
Cysts/tumors
Polycystic Kidney Disease
What are abnormal findings with liver palpation?
Firmness
Bluntness/rounding of edge
Surface irregularities
What are the three peritoneal signs?
Guarding
Rigidity
Rebound tenderness
WWhat does a positive rebound tenderness in RLQ suggest?
Appendicitis
What is the Rovsing’s sign?
Normal
Press gently and deeply in LLQ and look for pain in RLQ
What is the variation of Rovsing’s sign aka referred rebound tenderness?
Press gently and deeply in LLQ and QUICKLY withdraw fingers, looking for pain in RLQ
What are the 2 wats to do psoas sign?
- Resisted straight leg raise
2. While lying on L side, extend pt’s R leg @ hip
What is a positive psoas sign?
RLQ pain suggests inflamed appendix
What is obturator sign?
With pt supine, flex R leg at hip, bend the knee, and then rotate leg internally @ hip
What is a positive obturator sign?
RLQ pain may indicate inflamed appendix
What is the shifting dullness technique?
Supine: find border of tympany and dullness
THen roll on side and see if it moved
What does a positive shifting dullness test suggests/.
Ascites
What is the fluid wave technique?
Stabilize mid-abdomen and tap one side and see if a fluid wave hits your hand on the other side
How is Murphy’s sign tested?
With your fingers under the right ribs, ask patient to take a deep breath and look for a SUDDEN stop in inspiratory effort
What does a positive Murphy’s sign suggest?
Acute cholecystitis
Psoas, Obturator, and Rovsing’s are helpful in the assessment of peritoneal irritation, which can be associated with:
Appendiceal inflammation
Shifting dullness and fluid wave are helpful in the assesssment of:
Ascites
Sudden pain the RUQ during inspiration constitutes a positive:
Murphy’s sign
Ventral hernias can be identified by asking the pt to:
Raise head and shoulders off the table
