Abdominal Exam

Question 1

Most common abdominal symptoms

Answer 1

Pain

Alteration of bowel habits (constipation, diarrhea)

Indigestion/heartburn

Question 2

Symptom characterization for bowel habits

Answer 2

Diarrhea: # of stools per day, loose or watery, blood or mucus or none, color

Constipation: Frequency of BM, straining, blood

Question 3

Symptom characterization for abdominal pain

Answer 3

• Onset
• Provocation
• Palliation
• Quality
• Region
• Radiation
• Severity
• Timing
• Associated symptoms

Question 4

Symptom characterization for bloody stool

Answer 4

• Volume of blood
• Rapidity of bleeding (frequency and # of events)
• Color
• Location (see location card)

Question 5

Location of GI Bleeding

Answer 5

Question 6

Appendicitis symptom constellation

Answer 6

mild crampy peri-umbilical pain becoming steady more severe and

localizing to RLQ, anorexia, n/v

Question 7

Cholecystitis symptom constellation

Answer 7

episodic “attacks”, right upper abdomen,

radiates to right scapula or shoulder

Question 8

Abdominal contour

Answer 8

Question 9

Observation of the abdominal surface

Answer 9

Question 10

For the abdomen, always do ___ before ___.

Answer 10

For the abdomen, always do auscultation before palpation.

Palpation may induce bowel sounds when there are none at rest.

Question 11

Auscultation of the abdomen

Answer 11

Question 12

Location of important abdominal vasculature

Answer 12

Question 13

Percussion of the abdomen

Answer 13

Question 14

Percussing the liver

Answer 14

Question 15

Percussing the spleen

Answer 15

Question 16

Traube’s space

Answer 16

Area bounded by left sixth rib superiorly, left anterior axillary line laterally and left costal margin inferiorly

Question 17

Palpation of the abdomen

Answer 17

Question 18

Light palpation

Answer 18

Question 19

Deep palpation

Answer 19

Question 20

Palpating the liver

Answer 20

• Left hand behind patient (~11th or 12th ribs) on right side and press forward
• Right hand on patient’s abdomen lateral to rectus
• Fingertips well below lower border of dullness
• Press up and in as you ask patient to take deep breath. If palpable liver edge will move down and touch fingertips
• Normal liver edge-soft, smooth and with inspiration palpable ~ 3cm below RCM in MCL

Question 21

“Hooking technique” for liver palpation

Answer 21

Question 22

Palpating the spleen

Answer 22

• Left hand reaches around patient to support and press forward on left lower rib cage
• Right hand below LCM presses in toward spleen
• Start low (well below a possibly enlarged spleen!)
• Ask patient to take deep breath
• If palpable spleen tip will move down and tap fingertips
• Normal spleen is not palpable
• Repeat with patient on RIGHT side-gravity brings spleen forward and to the right

Question 23

Palpation of the aorta

Answer 23

Question 24

Example of normal abdominal exam report

Answer 24

Question 25

Example of abnormal abdominal exam report

Answer 25