Abdominal Exam Lab

Question 1

Order of Abdominal Exam

Answer 1

Inspect
Auscultate
Percussion
Palpation

Question 2

How do you drape a pt for abdominal exam?

Answer 2

have pt bring gown below nipple line & place drape @ level of ASIS (hip bone)

Question 3

What is a Cullen sign?

Answer 3

ecchymosis around umbilicus (secondary to hemorrhage)

Question 4

What is a grey turner sign?

Answer 4

flank ecchymosis secondary to hemorrhage

Question 5

Where and what do you auscultate in abdomen exam?

Answer 5

all 4 quadrants (RUQ, LUQ, LLQ, RLQ)

for bowel sounds & vascular sounds

Question 6

What are normal bowel sounds?

Answer 6

5-34 clicks or gurgles per minute

Question 7

Percussion of liver

Answer 7

6-12 cm @ mid-clavicular line on right (should be dull)

Question 8

Percussion of spleen

Answer 8

from ribs 6-10 @ mid-axillary line on L

Question 9

Order of palpation

Answer 9

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)

Question 10

What does rebound tenderness indicate?

Answer 10

pain upon REMOVAL of pressure on abdomen

peritoneal inflammation

Question 11

What is guarding?

Answer 11

assoc w/ palpation of abdomen

voluntary tightening of ab muscles secondary to pain

Question 12

What is rigidity?

Answer 12

assoc w/ palpation of abdomen

abdomen is hard & involuntary reflex contraction of abdominal wall

Question 13

What is visceral abdomen pain?

Answer 13

secondary to distension, stretching, or contracting of organs

not localized

felt in midline @ level of structure involved

Question 14

What is parietal abdomen pain?

Answer 14

secondary to inflammation in parietal peritoneum

localized pain

aggravated by movement or cough & alleviated by sitting still

Question 15

What is the McBurney’s point test?

Answer 15

rebound tenderness/pain @ 1/3 distance from ASIS to umbilicus

+ test is pain that indicates possible appendicitis

Question 16

What is Rovsing’s sign/test?

Answer 16

pain in RLQ upon palpation if LLQ

+ test is pain that indicates possible appendicitis

Question 17

What are the 2 tests that are clinically significant for appendicitis?

Answer 17

McBurney’s point (pain)

Rovsing’s sign (pain)

Question 18

What is a positive iliopsoas m test?

Answer 18

increased abdominal pain when pt flex hip v resistance

indicates irritation of psoas m due to inflammation of appendix

Question 19

What is a positive obturator m test?

Answer 19

R hypogastric pain when flex pt R thigh @ hip & rotate leg internally @ hip

Question 20

What is a positive heel strike test?

Answer 20

abdominal pain when strike pt heel when pt is supine

indicates possible appendicitis or peritonitis

Question 21

When do you palpate the liver?

Answer 21

@ level of R 11 & 12th ribs

during inhalation

Question 22

What is a positive ascites test?

Answer 22

impulse from 1 side of abdomen is transmitted to other side of abdomen

Question 23

What is a Murphy sign?

Answer 23

when palpate for gall bladder under R costal margin during inhalation

+ test is pain or stop of inhalation that indicates acute cholecystitis or cholelithiasis

Question 24

What is a Courvoisier’s sign?

Answer 24

enlarged non-tender gall bladder

indicates pancreatic disease/cancer

Question 25

Should you be able to palpate the spleen?

Answer 25

NO, normal spleen should NOT be palpable

Question 26

What does Lloyd punch/kidney punch or CVA tenderness indicate?

Answer 26

+ test is pain & indicates infection around kidney, pyelonephritis or renal stone

Question 27

How do you palpate the kidneys?

Answer 27

in RUQ & LUQ just below costal margin

press anteriorly from under pt & press down on top of abdomen during peak of pt inhalation

Question 28

What is normal finding for aorta palpation?

Answer 28

palpate above umbilicus, slightly to L of midline

estimate width of aorta & normal is 2-3cm in width w/ pulsation in anterior-inferior direction