Abdominal Exam

Question 1

first thing to do before starting abdo exam

Answer 1

introduce self, wash hands, DRAPE ; on legs, ask patients to expose abdomen by moving their gown up to their brawline and shorts to hip bone

Question 2

after draping, you identify. what structures to identify?

Answer 2

1. RUQ: gall bladder, liver
2. Epigastric area: pancreas
3. Left upper quadrant: stomach, spleen
4. periumbilical: kidneys
5. Right lower quadrant: appendix
6. LLQ: colon
7. suprapubic: reproductive organs and intestine

Question 3

after identifying anatomy, what do you do?

Answer 3

inspection:

scars

shapes; diastasus rectus hernia, asymmetry, bulging

masses

discoloration bruising; grey turners sign, cullens sign- which could indicate retroperitoneal bleeding or intraperitoneal bleeding.

redness

movement: respriation and peristalsis
- straiae
- petechiae and ecchymosis.

Question 4

after inspection is auscultation. what do you auscultate for and where?

Answer 4

auscultate bruits and bowel sounds which could indicate turbulent blood flow

BRUITS: superior epigastric, abdominal aorta, renal arterise, iliac, femoral

BOWEL SOUNDS: all four quadrants; characterize it as PITCH AND FREQUENCY

Question 5

how should you characterize bowel sounds

Answer 5

pitch and frequency

Question 6

what is after auscultation?

Answer 6

percussion:

1. ASK IF THERE IS COUGH TENDERNESS
   - note tympanny or fullness in all quadrants

Percuss for CVA angle– ask them to sit up at edge of bed and percuss the CVA. patients with an inflammatory process in kidney will frequently complain of pain when CVA is percussed

Question 7

what must you do before you start percussing the patient

Answer 7

you must ask if they have cough tenderness– sign of peritonitis.

• then percuss in all quadrants and for the CVA angle

Question 8

after percussion is palation, what are you assessing for?

Answer 8

assess for guarding, tenderness, pain and rigidity– signs of peritonitis.

• superficial : tenderness and guarding
• deep: organomegaly, masses, tenderness
• palpate all quadrants and then assess for abdominal wall tenderness; place hand on lower abdoment and ask them to do a sit up.

Question 9

after palpating superficially and deeply for organomegaly, what is next? explain (5 tests)

Answer 9

special tests;

1. mcburney sign for appendicitis. landmark the umbilicus and asis. draw straight line on right side. 2/3 distal from umbilicus. palpate while they cough.
2. murphys sign. ask the patient to breath deeply inand out. when they breath out, push hand into rib cage around the gall bladder in RUQ. when they breath back in, the liver and GB is drawn down, if there is a sharp pain, it might be cholecystitis.
3. Rovsings sign; palpate on the left point 2/3 distal from umbilicus in between the ASIS. when they cough, it’ll shift and put iar pressure on the right side (where the appendix is) and it will elicit pain.
4. psoas sign: for appendicitis; lie on left side and extend their right hip back
5. obturator sign; for assessing appendicitis; pain with internal rotation of the right hip and when the knee is flexed

Question 10

after special tests, what must you state?

Answer 10

that you will do a DRE and a pelvic exam in addition to this abdominal exam