Abdominal Semiotics

Question 1

Abdomen can be?

Answer 1

Flat, rounded, protuberant, scaphoid.

Question 2

Abdominal exam order?

Answer 2

auscultation, palpation, inspection, and percussion

Question 3

Abdominal exam where do you start?

Answer 3

Start with non painful non tender areas with light palpation.

Question 4

Liver palmation?

Answer 4

T1 : Left hand supports back at level 11 12. Right hand presses in border of liver, ask patient for deep breath.

T2 hooking technique : Both hands side by side on R abdomen and feel below border, ask for deep breath. Useful for obese patients.

Question 5

Spleen palpation?

Answer 5

Normally spleen cannot be palpated. If it is palpable on the left side it may indicate splenomegaly.

Question 6

Blumberg sign?

Answer 6

Rebound tenderness of the abdomen upon release of pressure, not to be performed in painful area.

Question 7

McBurney sign?

Answer 7

Pain upon pressure of the McBurney point (2/3 of the umbilical-iliac line)
Pure appendicitis: pain reported centrally (midline)
Peritonitis: pain reported locally
Assessing for appendicitis, check for involuntary guarding (and rebound tenderness) in the right lower quadrant.

Question 8

Rovsing?

Answer 8

Mirrors the McBurney sign on the opposite side.
Pain elicited by displacement of viscera to the opposite side, reported on the McBurney point

Question 9

Obturator and Psoas sign?

Answer 9

Obturator sign Flex the patient’s right thigh and rotate the leg Pain Appendicitis

Psoas sign Patient lying on the left side Dorsiflexion of the right leg Pain (Retrociecal) appendicitis

Question 10

Giordano sign ?

Answer 10

Tenderness in the costovertebral angle pain (severe) when hitting a hand placed on the costovertebral angle.

Pyelonephritis, kidney stones (hydronephrosis).

Question 11

Courviosier terrier sign?

Answer 11

Palpation of a bag-like mass in the right hypochondrium
Not painful

Slow and chronic obstruction of the biliary tree, i.e.: biliary or pancreatic cancer

Question 12

Fluid wave test?

Answer 12

Two people
One assistant places the ulnar side on the hands on the midline (thus stopping transmission of waves through superficial tissues)
Place hands on both sides of the abdomen, tapping on one side and feeling a fluid-wave transmission to the other side.
Ascites (free fluid in peritoneum).

Question 13

Percussion?

Answer 13

Dullness/hypophonesis  fluid, masses, stools, hypertrophy

Normal tympany

Increased (hyper)tympany  air/gas, perforation
Percuss over all four quadrants