Abdominal Examination

Question 1

Observation

Answer 1

Ask patient to take their top off and to lie facing up on the bench

Colour:
Yellowing could indicate Jaundice,
Pale skin could indicate anemia, LBP or Infection
Bruising could indicate Diabetes or Alcoholism.
Cushings syndrome – When body makes too much cortisol, Purple-coloured striae (stretch marks) of the abdomen is pathognomic of cushings syndrome
Scars – Caesarian, Liver transplant, Kidney surgery
Protuberent Abdomen – Pregnancy, Ascitic fluid or Tumours.

Lumps and Bumps =
* Visible Hernias
* Visible Peristalsis (Involuntary contraction and relaxation of longitudinal and circular muscles through digestive tract)
* Organ tumours, Lipoma (Bening tumours)
Spider angioma – (marks on skin enlarged blood vessel) Especially more than one is a common sign of liver disease
Dilated Abdominal veins – Portal hypertension caused by Cirrhosis (Liver scaring)

Stretch marks: Obesity, Cushing’s, Pregnancy
Rashes – Psoriasis, Meningitis
Pulsations – Could be sign of AAA

Question 2

Hernia Test

Answer 2

Ask patient to bend their knees and to pop their hands on their hip
So we are going to want to add abdominal pressure one way we can do this is by
* Ask patient to do half a sit up
* Ask patient to cough a couple times

Question 3

Auscultation

Answer 3

Make sure all area is exposed, Knees bent and patient hands on the back of their hip.

Start in the Right iliac region medially to laterally in each quadrant and work your way up the quadrants
Listen through inspiration and expiration -> listen for abnormal sounds

Bowel sounds
* Normal range is 5-35 bowel sounds per minute.
* Increased bowel sounds could indicate diarrhoea or that they just ate, IBS.
* Decreased bowel sounds could indicate constipation and complete absence of bowel sound indicate paralytic ileus or Bowel Ileus

“If I didn’t hear any bowel sounds I would auscultate the patient for 3 mins” (mention in exam)
mention in exam
Vessels-
– Bruits sound (whooshing sound which could be associated with narrowing of renal artery)
-Venous Hum (Portal vein hypertension),
-Friction rub (rubbing noise, could indicate cancer in liver)

Question 4

Auscultation of abdominal vessels

Answer 4

• Aorta
• Renal Artery
• Iliac Artery
  Trying to hear Bruits (turbulent blood flows), Venus hums.
  Know where each on is

Question 5

Percussion of abdomen

Answer 5

Allows you to distinguish whether abdominal distension is due to solid or cystic tumors, ascities, or gas
Percussion – 14 per side
Dullness sound could indicate (food, a mass , organ)
Medial to lateral percussion

Question 6

Light palpation

Answer 6

Communicate with patient and get consent
Palpation hand has to be flat and starting laterally to medially
Palpating for Tenderness & Abdominal masses in a particular region or quadrant
Also checking for guarding and rigidity

Question 7

Deep palpation

Answer 7

• Deep palpation each quadrant/region
• Rebound tenderness – if painful could indicate Peritonitis (Mcburneys point) – Refers to the point on the lower right quadrant of the abdomen at which tenderness is maximal in cases of appendicitis. Positive sign would be tenderness and pain upon release from palpation of the right lower quadrant.
• AAA test – Palpate with both hands laterally to medially until you feel a pulse. 5.5cm visible pulse
  increase risk of AAA.

Question 8

Liver - percussion

Answer 8

Start percussion well above liver and percuss down until you hear dullness (superior border) mark it
Then from the right iliac region percuss up until you hear dullness (Inferior border) Liver could be enlarged. (6cm-12cm normal)

• Limitation of the test? Pneumonia and COPD which could cause a hyperinflated lung showing a dullness sound lower down than where the liver actually is.
• Females because of breast only percuss inferior border (mention in exam)

Question 9

Liver - palpation

Answer 9

Ask patient to breathe in and on the breathe out hook into the ribs and feel liver. Healthy individuals no feeling as liver is not inflammed.

Question 10

Murphy’s sign

Answer 10

Galbladder pathology, communicate with patient that it could be quite sore
Hooking up into the ribs during patient inspiration as it pushes gallbladder forward.
* Positive sign would be pain or can’t/stop breathing in

Question 11

Ascities shifting dullness

Answer 11

Test with percussion from left illiac region across hypogastric region to right iliac region.
Should be Dull -> Tympanic -> Dull
Ask patient to lie on their side for 30 seconds (Fluid will drain down)
A person with Ascietes the fluid will drain to the other side and percussion would sound
Dull -> Dull -> Dull to Tympanic -> Tympanic (shifting dullness)

Question 12

Spleen - Percussion

Answer 12

Percussion
Infection can cause spleen to increase in size, Grade 5 can cause spleen to expand big.
* Start percussion from lower right quadrant and work towards left hypochondriac region
(not expecting to feel it on healthy individuals)

Question 13

Spleen - Palpation

Answer 13

Palpaiton
Start from lower right quadrant, Keep hands flat and start palpating through each breahte cycle and do the crawl/walk with hands while palpating to move up

Question 14

Kidney - Palpation

Answer 14

Palpation
* Right kidney is more palpable than left
* Make a sandwhich and with left hand push and with right palpate into the ribs
(Healthy individuals you wouldn’t feel it)
Noting any tenderness and palpating for enlarged kidney - Causes of enlarged kidney are Hydronephrosis Or Polyscystic Kidney Disease

Question 15

Kidney - Strike

Answer 15

Kidney Strike
If they have lower back pain but you and you want to rule out the kidney.
* Flat hand on the patients back (where the kidney is)
* Firm fist hit your hand on the patient back
Someone with kidney pathology would feel pain when you do this.