Abdominal Examination Flashcards
State the 8 stages of your abdominal examination
- Introduction
- General inspection
- Hands & arms
- Head & neck
- Chest
- Abdomen
- Legs
- Completing the examination
Describe what you must do in the introduction stage of your abdominal examination
- Introduce yourself
- Check pt name & DOB
- Explain examination and gain consent
- Offer chaperone
- Check if in any pain
- Wash hands
Describe what you must do in the general inspection stage of your abdominal examination
Inspect from end of bed:
Surroundings:
- NBM, nutritional supplements, NG tube, TPN bags, stoma bags, catheter
Patient:
- Look well or unwell e.g. look at their colour
- Conscious level
- Any obvious pain
- Nutritional status
- Abdominal distension
- Scars
*
Describe what you must do in the hands & arms stage of your abodominal examination
- Liver flap/asterixis
- Inspection: clubbing, koilonychia, leuconychia, dupuytren’s contractures, palmar erythema, spider naevi
- Radial pulse
- Inspect for arteriovenous haemodialysis fistula (and examine- look, feel, listen- if present)
Describe what you must do in the head & neck stage of your abdominal examination
- Inspect eyes: xanthelasma, conjuctival pallor, corneal acrus, scleral icterus, Kayser-Fleischer ring, yellow sclera
- Inspect mouth: apthous ulcers, angular stomatitis, gingivitis, buccal pigmentation, glossitis, oral candidiasis, halitosis, fetor hepaticus, dry tongue, dentition
- Palpate regional lymph nodes (submental, submandibular, pre-auricular, post-auricular, occipital, anterior cervical, posterior cervical)
- Palpate Virchow’s nodes
Describe what you must do in the chest stage of your abdominal examination
Inspect for:
- Spider naevi
- Gynaecomastia
The abdomen stage of the abdominal examination is lengthey hence it can be divided into 4 stages; state these stages
- Inspection
- Palpation
- Percussion
- Auscultation
Describe what you must do in the inspection part of the abdomen stage of the abdominal examination
Inspect for:
- Distension
- Symmetry & shape
- Pulsations & peristalsis
- Venous distension
- Scars
- Stoma
- Other e.g. Cullens, Grey Turners
Describe the palpation section of the abdomen stage of your abdominal examination
- Palpate hernia: Ask pt to lift head up or turn head ot side and cough. Comment on warmth & reducibility. Auscultate & comment on bowel sounds.
- Light palpation (9 areas)
- Deep palpation (9 areas)
- Rebound tenderness (if tenderness elicited earlier)
- Percussion tenderness (if tenderness elicited earlier)
- Liver palpation
- Spleen palpation
- Kidneys palpation
- Bladder palpation
- Abdominal aorta palpation
Describe the percussion section of the abdomen stage of the abdominal examination
Percuss:
- Liver
- Spleen
- Bladder (from epigastrium down to symphysis pubis)
- Ascites (shifting dullness or fluid thrill)
Describe the auscultation section of the abdomen stage of the abdominal examination
Auscultate:
- Bowel sounds
- Aorta
- Renal arteries
- Liver bruits
Describe what you must do in the legs stage of your abdominal examination
Inspect for:
- Erythema nodosum
- Pyoderma gangrenosum
Describe what you must do in the completing the examination part of your abdomen examination
Offer to inspect:
- Hernial orifices
- External genitalia
- DRE
- Bedside: temp, urinalysis
How must you position your patient for an abdominal examination?
*HINT: you may have to change the position of your pt
- For initial general inspection lie them at 45o
- For abdomen stage lie pt flat with arms by side
At what level should you be when palpating the abdomen and why?
- Level of patient
- To you can look at patient and see if they are in any pain
Describe how you test for rebound tenderness
What does rebound tenderness indicate?
- Press deeply/firmly on abdomen then quickly release and observe pt for pain
- Rebound tenderness (also known as Blumburg’s sign) indicates peritonitis
What is McBurney’s sign and what is it indicative of?
- Tenderness at McBurneys point (1/2 way from ASIS to umbilicus)
- Appendicitis
Describe how you palpate the liver
- Ask patient to take some deep breaths
- Starting in RIF use inner edge of index finger and hand
- Move towards right costal margin
*NOTE: liver should not be palpable unless enlarged. If it is enlarged you must make note of its size: measure as the number of fingers below the costal margin in mid clavicular line then percuss along mid-clavicular line to confirm. Also comment on nodularity
If the liver is palpable on examination and therefore is enlarged, describe how you would measure the size of the enlarged liver
- Measure as the number of fingers below the costal margin in mid clavicular line
- Then percuss along mid-clavicular line to confirm
- Also comment on nodularity
Describe how you palpate the spleen
- Ask patient to take some deep breaths
- Start in RIF
- Using inner edge of index finger & hand, move towards the left costal margin
- Move hand on expiration
NOTE: spleen should not be palpable unless splenomegaly is present
If the spleen is palpable on examination and therefore is enlarged, describe how you would measure the size of the spleen
- Measure as number of fingers below the costal margin in the mid-clavicular line
- Then percuss along the same line as palpated
Describe how you would palpate the kidneys
- Place your left hand on patients back, below ribs and underneath right flank
- Place your right hand on patients anterior abdomen just under costal margin
- Push your fingers together, pushing upwards with left hand and downwards with right hand
- Ask pt to take a deep breath and you may lower pole of kidney between your hands
- If you feel the kidneys, take note of size and consistency
*NOTE: kidneys not usually palpalbe unless enlarged but right kidney may be palpable if patient has low BMI
