Abdominal Examination Flashcards
Main Methods of Medical Exam
Inspection (observation)
Percussion
Palpation
Auscultation
Abdominal exam
Inspection
Auscultation
Percussion
Palpation
Major Landmarks
Costal margins Anterior superior iliac spine Midline – indicated by the linea alba Inguinal ligament Symphysis pubis Rectus abdominus
4 quandrants
Right upper quadrant (RUQ)
Left upper quadrant (LUQ)
Right lower quadrant (RLQ)
Left lower quadrant (LLQ)
How many different regions?
9
What are the 3 midline areas?
Epigastric
Umbilical
Hypogastric or suprapubic
What is in the RUQ?
liver, the gall bladder, duodenum the upper portion of the pancreas and the hepatic flexure of the colon
What is the RUQ tender with?
hepatitis, cholecystitis and with the formation of a peptic ulcer
What do doctors asses with the RUQ?
localize pain and tenderness
What forms the LUQ?
the median plane extending to the left of the patient and with the umbilical plane to the left rib cage
What is found in the LUQ?
stomach, the spleen, the left portion of the liver, and the main body of the pancreas. The left portion of the kidney and the adrenal gland are also found in this quadrant. The splenic flexure of the colon and the bottom portion of the colon also sit in the left upper quadrant
What is the LUQ tender with?
appendicitis and abnormalities of the intestines such as malrotation
Borders of LLQ:
below the umbilicus plane
Organs in LLQ:
the bottom portion of the colon, the sigmoid colon, the left ovary, Fallopian tube and the left uterine tube
Pain in the LLQ can be a symptom of:
Abdominal pain in the LLQ may be a symptom of colitis, diverticulitis, or ureteral colic. Pain in this region may also be caused by ovarian cysts or a pelvic inflammation. Tumors found in this region can be serious determinants of colon or ovarian cancer
Regions of abdominal area
right hypochondriac right lumbar right iliac eipgastric umbilical hypogastric left hypochondriac left lumbar left iliac
What should be inspected?
scars, lesions, rashes, or striae (stretch marks).
What can indicate Cushings?
Purple-pink striae
What should be observed with the umbilicus?
Should be midline
Look for hernia
Inverted or everted
What is the normal range of sounds?
5 and 34 clicks or gurgles per minute
Bruits
sounds of turbulent arterial flow - atherosclerosis
What should be listened?
Renal arteries
Iliac arteries
What has a dull sound?
solid or liquid filled structure
What has a resonant sound?
air filled
tympanitic- stomach
How do the tones change when percussing the abdomen?
resonant: lung
dull: liver
resonant: intestines
What should be noted with palpation?
guarding, tenderness, rigidity, or masses
Order of palpation?
start R lower - R upper - L upper - L lower
Normal width of the aorta?
2.5-3.0 cm
Positive rebound sign:
If pain is worse on withdrawal than on initial palpation
What is the psoas sign an indication of?
appendicitis
Psoas Sign:
Resist hip flexion of the right leg in supine
With patient left sidelying, passively stretch the right hip into extension
Positive if it elicits abdominal pain
What is Murphy sign an indication of?
acute cholecystitis
Murphy Sign:
Hook left thumb or fingers of your right hand under the right costal margin where lateral border of rectus meets costal margin
Have patient take a deep breath
Positive if the patient has a sharp increase in tenderness with a sudden stop in inspiratory effor
Emergency situation:
Visible of palpable pulsatile mass in the epigastric area – suspected large abdominal aortic aneurysm (AAA)
Positive rebound sign or other signs of peritoneal inflammation
