Abdominal Examination Flashcards
Protuberant means
Protuberant = Distention
Protuberant abdomen can be due to
OFATOA
Obesity Air/Gas Ascites Ovarian Cyst (Large) Fecal impaction Tumor
Inspect abdomen for (BMH)
- Bulges
- Masses
- Hernias
What is hernia?
Protrusion of viscera through muscle wall
Everted umbilicus (MAH)
- Mass
- Ascites
- Hernia
Caput Medusa
Caput Medusa
• Portal HTN
• Cirrhosis
• IVC obstruction
What is the Cullen’s sign?
Blood tracks from retroperitoneum to umbilicus along gastrohepatic & falciform lig.
Pulsations/Movement
• Marked Pulse of Aorta (HAT)
- HTN
- Aortic insufficiency
- Thyrotoxicosis
May indicate obstruction
Marked Visible Peristalsis w/ distention
No bowel sounds after _____indicates
• Absent (after 5 mins) = poss. Ileus
Auscultation 4 areas to cover (ARIF)
4 Areas to check over: • Aorta • Renal arteries • Iliac arteries • Femoral arteries
Systolic bruit –>indicates
stenosis/occlusion
Dullness of abdomen can indicate (MAD)
- Mass/Tumor
- Ascites
- Distended bladder
Hyperresonance may indicate
• Gaseous distention
Dullness above_________ indicates _______such as ____ and _______
- Dullness above 5th interspace = Lung Ds.
- Pleural effusion
- consolidation
Normal adult liver span
Normal adult span 6-12cm
Stratch test
Alternate method to measure _______
4 steps PWBS
Alt. method to measure Liver Span
• Place stethoscope over Liver
• With one fingernail, scratch short strokes starting in RLQ, moving up
• Border found when scratch is heard in stethoscope
• Sound heard better through solids than air
**Splenic Dullness forward______indicates ________
Dullness forward of Midaxillary line = enlargement
• If Spleen dull–>
Splenomegaly
For splenic dullness
- Percuss for dull note from 9th to 11th interspace just behind Midaxillary line
- Dullness forward of Midaxillary line = enlargement
- Next, percuss @lowest interspace Anterior axillary line
Percussion and spleen what does it help with ?
This method gives early detection mild-moderate splenomegaly before spleen become palpable.
Percuss kidneys
At 12th rib, CVA angle
• If pain = inflammation of kidney or paranephric area
Abdomen palpation
Palpate Abdomen Surface & Deep Areas – mass or tenderness
• Start w/ Light palpation
For abdominal palpation
Press 1cm
Note any abnormalities:
L-TRAMB
- Muscle guarding
- Large masses
- Tenderness
- Rigidity
- Boardlike = protective mechanism
- Acute inflammation peritoneum
Why do we use the bimanual technique?
to overcome resistance of large or obese abdomen
LIVER PALPATTION If felt costal margin =________ note:
>2cm below Enlarged • Note: • Tenderness • Consistency (hard, nodular)
Hernias can be (SIS)
Stranding
Incarcerated
Strangulated
If this organ is found enlarged ______during palpation what to do
SPLEEN
If enlarged, Stop
• Enlarged spleen very friable – can rupture easily
Enlarged SPLEEN Indicates –>
Mononucleosis or Trauma
AORTA: • Prominent Lateral Pulse (or >4cm) =
Normal is
Aortic aneurysm
2.5 – 4cm wide
Pain @ McBurney’s point =
Acute appendicitis
Rebound tenderness also knonw as
Rebound Tenderness (Blumberg Sign)
McBurney’s point
Line from ______
Correlates to _________
Line from ASIS to Umbilicus
~ 1/3 of the way up
Correlates to base of appendix
Appendicitis : • Iliopsoas Muscle Test
- Pt. supine
- Ask pt. raise Right leg (keep knee straight)
- Push down against lower thigh
- RLQ pain = appendicits
Appendicitis: Obturator Test
- Pt. supine
- Flex hip & knee 90°
- Internally & Externally rotate leg
- Pain = appendicitis
Ascites : Fluid wave test
Fluid Wave Test
• Ulnar edge of another examiner’s hand, or pt.s hand firmly on midline
• Place your L. hand on pt. right side
• Using your R. hand, Firmly strike pt. left flank
• If ascites present, fluid wave transmits through abd. to left hand
• If distended from gas, no wave is felt
WHen there is ASCITES there will be
SHIFTING DULLNESS
Shifting Level indicates= ______present
• Indicates shifting level of dullness = fluid presentd
Shifting level positive with?
Will not detect?
- Shifting level positive with Large Volume Ascites
* This method will not detect < 500 ml of fluid
Inspiratory Arrest
(Murphy’s Sign)
Murphy’s sign–>
- Hold fingers under liver border
- Ask pt. Deep Breath
- If they wince or stop inspiration midway = cholecystitis
Height correlates with
LIVER SIZE
