Abdominal Exam Lab Flashcards
Order of Abdominal Exam
Inspect
Auscultate
Percussion
Palpation
How do you drape a pt for abdominal exam?
have pt bring gown below nipple line & place drape @ level of ASIS (hip bone)
What is a Cullen sign?
ecchymosis around umbilicus (secondary to hemorrhage)
What is a grey turner sign?
flank ecchymosis secondary to hemorrhage
Where and what do you auscultate in abdomen exam?
all 4 quadrants (RUQ, LUQ, LLQ, RLQ)
for bowel sounds & vascular sounds
What are normal bowel sounds?
5-34 clicks or gurgles per minute
Percussion of liver
6-12 cm @ mid-clavicular line on right (should be dull)
Percussion of spleen
from ribs 6-10 @ mid-axillary line on L
Order of palpation
light palpation (tips of fingers, 1 cm depth in all 4 quadrants)
moderate palpation (fingers or side of hand, 2-3 cm in all 4 quadrants)
deep palpation (fingers, more than 3 cm in all 4 quadrants)
What does rebound tenderness indicate?
pain upon REMOVAL of pressure on abdomen
peritoneal inflammation
What is guarding?
assoc w/ palpation of abdomen
voluntary tightening of ab muscles secondary to pain
What is rigidity?
assoc w/ palpation of abdomen
abdomen is hard & involuntary reflex contraction of abdominal wall
What is visceral abdomen pain?
secondary to distension, stretching, or contracting of organs
not localized
felt in midline @ level of structure involved
What is parietal abdomen pain?
secondary to inflammation in parietal peritoneum
localized pain
aggravated by movement or cough & alleviated by sitting still
What is the McBurney’s point test?
rebound tenderness/pain @ 1/3 distance from ASIS to umbilicus
+ test is pain that indicates possible appendicitis
What is Rovsing’s sign/test?
pain in RLQ upon palpation if LLQ
+ test is pain that indicates possible appendicitis
What are the 2 tests that are clinically significant for appendicitis?
McBurney’s point (pain)
Rovsing’s sign (pain)
What is a positive iliopsoas m test?
increased abdominal pain when pt flex hip v resistance
indicates irritation of psoas m due to inflammation of appendix
What is a positive obturator m test?
R hypogastric pain when flex pt R thigh @ hip & rotate leg internally @ hip
What is a positive heel strike test?
abdominal pain when strike pt heel when pt is supine
indicates possible appendicitis or peritonitis
When do you palpate the liver?
@ level of R 11 & 12th ribs
during inhalation
What is a positive ascites test?
impulse from 1 side of abdomen is transmitted to other side of abdomen
What is a Murphy sign?
when palpate for gall bladder under R costal margin during inhalation
+ test is pain or stop of inhalation that indicates acute cholecystitis or cholelithiasis
What is a Courvoisier’s sign?
enlarged non-tender gall bladder
indicates pancreatic disease/cancer
Should you be able to palpate the spleen?
NO, normal spleen should NOT be palpable
What does Lloyd punch/kidney punch or CVA tenderness indicate?
+ test is pain & indicates infection around kidney, pyelonephritis or renal stone
How do you palpate the kidneys?
in RUQ & LUQ just below costal margin
press anteriorly from under pt & press down on top of abdomen during peak of pt inhalation
What is normal finding for aorta palpation?
palpate above umbilicus, slightly to L of midline
estimate width of aorta & normal is 2-3cm in width w/ pulsation in anterior-inferior direction
