Competency 1: Abdominal Exam Flashcards
Proper order of steps for abdominal exam
- Inspection
- Ausculation
- Percussion
- Palpation
What are you looking for during inspection of the abdomen?
- Color and pigmentation
- Contour/symmetry
- Arterial pulsations
- Peristalsis
- Signs of trauma
What is this called; causes?
- Cullen Sign
- Ecchymosis around the umbilicus (periumbilical) secondary to hemorrhage
- Pancreatits; ectopic pregnancy
What is this called; causes?
- Grey Turner Sign
- Ecchymosis of the flanks (pancreatitis)
Why is it important to auscultate before performing perucssion or palpation during an abdominal exam?
These maneuvers may alter the frequency of bowel sounds
We listen to bowel sounds w/ what part of diaphram; what is normal and what is abnormal?
- Diaphragm of stethoscope
- Normal: 5-34 clicks or gurgles/min
- Abnormal: High pitched or decreased/absent sounds
*Listen in all 4 quadrants
What arteries do we listen to in abdomen; what part of stethoscrope for Bruits and what do Bruits suggest?
- Abdominal aorta, iliac, renal, and femoral arteries
- BELL of stethoscope for Bruits
- Bruits suggest vascular occlusion
We percuss the abdomen in all 4 quadrants to assess for?
- The amount and distribution of gas
- To identify possible masses
- Estimate the size of the liver and spleen
What sound is heard during percussion over the majority of the abdomen; what other sound may be heard?
Tympany: predominate sound in the abdomen‐ high pitched sound heard over air filled viscera
Dullness: non‐resonating/flat sound heard over solid organs or masses
Where do we do percussion of the liver; and what is its normal span?
- Right mid-clavicular line
Normal span:
- 6-12 cm in right mid-clavicular line
- 4-8 cm in midsternal line
What is the exprected spleen span and where
From ribs 6-10 at the mid-axillary line on the left
What are general considerations for palpation and order of palpation?
- Warm hands, if needed bend pt’s knees to relax abdominal messages, examine most tender areas last
- Light palpation: up to 1 cm depth
- Moderate: up to 2-3 cm depth
- Deep: more than 3 cm depth
What is rebound tenderness; indicates what?
Pain upon removal of pressure, rather than the application of pressure to the abdomen; indicates peritoneal inflammation
What is guarding of the abdomen?
Voluntary tightening of the abdominal muscles secodary to pain
What is ridgity of the abdomen?
Abdomen is hard, involuntary reflex contraction of abdominal wall
What is McBurney’s Point; what can it be indicative of?
- Rebound tenderness or pain 1/3 of the distance from the ASIS to the umbilicus
- Possible appendicitis/peritoneal inflammation
What is Rovsing’s sign and what is it indicative of?
- Pain in the RLQ during left-sided pressure
- Possible appendicitis (referred rebound tenderness)
What is the iliopsoas muscle test and what can it be indicative of?
- Have pt flex their hip against your resistance. Increased abdominal pain is a positive test.
- Indicates irritation of the psoas muscle from inflammation of the appendix
What is the Obturator muscle test and what is it indicative of?
- Flex the pt’s right thigh at the hip, with the knee bent, and IR leg at the hip. Right hypogastric pain is a positive test
- Indicates irritation of the obturator muscle from inflammation of the appendix
What is the heel strike test and what is it indicative of?
- With pt supine, strike patient’s heel. Positive test is abdominal pain.
- Indicates possible appendicitis or peritonitis
What is Murphy’s sign?
- Palpate deeply under right costal margin during inspiration.
- Positive test is pain and/or sudden stop in inspiratory efford
- Indicates acute cholecystitis or cholelithiasis
What is Courvoisier’s Sign; indicates?
Enlarged non-tender gallbladder. Indicative of pancreatic disease/cancer
What is Lloyd punch/CVA tenderness; indicates?
- Gently tap the area of the back overlying the kidney (costovertebral angles). Positive test is pain
- Indicates an infection around the kidney (perinephric abscess), pyelonephritis, or renal stone
How is abdominal aorta palpation performed; expected width and direction of pulsation?
- Palpate just above umbilicus, slightly to the left of midline
- Expected width: 2-3 cm, pulsation is an anterior-inferior direction
- Unexpected: >3cm in width, prominent lateral pulsation
