GI - 2 Examination of the Abdomen: Auscultation, Percussion & Palpation Flashcards
Positions appropriately and drapes (re-drapes as needed).
**Explain procedure:
** Today I will be performing an exam of your abdomen. This will involve looking at, touching, and listening to your tummy. If at any point you feel uncomfortable or hurts, please let me know.
Auscultates for bowel sounds, Bruits, and comments on findings and their significance. Comment on findings.
“Next, using the diaphragm of the stethoscope, I will be placing it on the right umbilicus (RLQ), listening for bowel sounds. Normal bowel sounds consist of clicks and gurgles, occurring at an estimated frequency of 5 to 34 per minute. Altered bowel sounds are common in diarrhea, peritoneal inflammation (peritonitis), and obstruction.”
(Because bowel sounds are widely transmitted through the abdomen, listening in one spot, such as the RLQ, is usually enough). [Only conclude they are absent after listening for 2 minutes. Absence of bowel sounds indicates peristalsis has ceased due to paralytic ileus or peritonitis. Changed sounds are common in diarrhea, peritoneal inflammation (peritonitis), and obstruction. Mechanical intestinal obstruction increases the volume and frequency of bowel sounds (high-pitched tinkling quality.]
“I will also be auscultating over the liver and spleen listening for friction rubs. Friction rubs are present in hepatoma, splenic infarction, and pancreatic carcinoma (choose one to include).” “Now, I will be switching to the bell of my stethoscope to auscultate for bruits which are lower frequency, abnormal blowing or swishing sounds resulting from turbulent flow due to narrowing stenotic) or partially occluded artery. First, I will be placing the bell above the umbilicus listening for aortic bruits. Next, I’ll place it 2-3 cm above the lateral umbilicus to listen for renal artery bruits, lateral to the umbilicus listening to the iliac artery bruits, and in the inguinal region listening for femoral artery bruits.”
[Present bruits could be indicative of a stenotic artery (ex. renal artery stenosis).]
Before percussion asks where it hurts. Percusses lightly in all quadrants. Comment on your findings. Comment on findings.
“Before I begin to touch you, do you have any pain? Ok I’m going to tap on four areas of your tummy.** (Do percussion on all 4 quadrants).** Percussion sounds were normal with areas of dullness and resonance as expected.”
All palpation should start from areas of least pain. Performs light palpation in all quadrants, for tenderness and superficial masses. Performs deep palpation in all quadrants. Comment on findings.
“Now I’m going to gently place my hands (palpate) in different areas (4 quadrants of abdomen) of your abdomen, feeling for any abdominal tenderness, muscular resistance, or superficial organs or masses. Are you in any pain? I do not feel any superficial masses or organs, any are of tenderness and the patient isn’t displaying increased resistance to palpation. Guarding or involuntary rigidity could suggest peritonitis.”
Parietal pain originates from inflammation of the parietal peritoneum (peritonitis) it is a steady, arching pain that is more severe than visceral pain and localized over structures. It is aggravated by movement or coughing. They prefer to lie still.
“Next, using the palmer surfaces of my fingers, I’ll be pressing deeply in all four quadrants of your abdomen. I am noting no palpable masses, or any other abnormal findings.”
Performs deep palpation for the aorta and abdominal masses if present e.g. tumors. Comment on findings.
“Now, I’ll be deeply pressing down on your abdomen feeling for your aorta or any abdominal masses that may be present. Can you relax for me? There were no signs of palpable masses present that would be indicative of a tumor or distended bladder.”
While the patient is supine, and abdomen relaxed, place both hands flat above umbilicus, position so that the fingers of each hand point toward the epigastrium and the ulnar borders of each hand run alongside the patients left and right costal margins. Occlude abdominal skin between the index fingers of one hand and probe for one side of the aorta at a time. The aorta might be felt as pulsatile mass (both lateral and vertical expansion). Non-aneurysm mass is palpable in thin patients. Diagnosis of AAA is done due to width, not the presence or intensity of pulsation. Aorta’s wider than 2.5 cm should be further investigated.
Assesses for Peritonitis by performing the cough test, assess for guarding, rigidity, rebound tenderness, etc. Comment on findings.
“Could you please cough for me? Did you have any pain when you were coughing? A negative cough test indicates that the peritoneum is not inflamed. Please lay down for me. I am going to be exposing your abdomen with your permission. Please let me know if this causes you any pain. I do not feel the patient displaying increased resistance to palpation nor is the patient saying that this hurt. This means the patient is not guarding, displaying rigidity, or rebound tenderness which if present would indicate the patient may have peritonitis.”
Peritonitis = rigidity or guarding in quadrants → infective = peptic ulcer, appendicitis, GI tract perforation
**Cough test **=Forced cough elicits pain
Rebound tenderness = increased pain on letting go of palpation
