GI - Abdo Exam Flashcards
How would you position them for an abdo exam?
Supine
On one pillow
Arms at sides and legs uncrossed
Expose from below breast to pubic hairline (i.e. pull up shirt and down jeans a little)
What could you see on abdominal inspection?
- Scars
- Pulsation
- Movement with respiration
- Skin lesions
- Scratch marks
- Shape (Scaphoid vs obese)
- Stoma
- Distended veins
- Petechiae (Pin-head red spots)
- Striae
- Distension
What would each inspection sign indicate?
Scars - Surgery or trauma
Pulsation - I.e. Aortic Aneurysm
Respiration - Should be present (Absent/shallow might mean pain)
Scratch marks - Chronic cholestasis or liver failure
Distended veins
- Caput medusae = Portal hypertension
- Vertically crossing chest = Vena Cava obstruction
Petechiae - Liver dysfunction
Striae - Weight loss
Distension - 5Fs (Fat, Faeces, Flatus, Fluid or Foetus)
How do you position for abdominal palpation?
Use a chair or adjust bed height so you can place hand flat on abdomen level with the forearm
How do you do basic palpation of the abdomen?
Ask about pain & Warm hands
Watch patients face for pain reactions during palpation
Lightly palpate all 9 regions
- Masses
- Tenderness (Parietal peritonitis)
- Guarding (Peritonitis or Anxiety)
- Rigidity (Peritonitis
Deeply palpate all 9 regions
- Tenderness
- Normally youd feel:
1) AA pulsation in Epigastrium
2) Caecal squelch
3) Desc/sigmoid colon + contents
4) ~Liver edge at right costal margin
How do you palpate the liver?
Start with hand in right iliac fossa
Dig in and up on expiration, hold while they inspire to feel the liver drop down
Repeat while moving you hand up in a fan shape towards the right costal margin until you feel it or you reach the ribs
Normal borders of the liver?
upper - 5th right intercostal space on full expiration
lower - Costal margin in mid-clavicular line on full inspiration
How do you palpate for the spleen?
Again start in right iliac fossa
Press up and in on expiration then feel for it on inspiration
Move diagonally up/across the abdomen towards left costal margin
Once you get to the ribs do bimanual palpation:
- Left hand pulls their lower ribs towards you
- Right hand palpates under costal margin
Normal border of the spleen?
9-11th ribs in left mid-axillary line
How do you palpate for the kidneys
Bimanual palapation:
- Right hand on abdomen & left underneath
- Take a deep breath and as they expire press hands together
- Then one more deep breath to see if you can feel kidneys
Then repeat on other side
Normal borders of kidneys?
Renal Angle of 12th rib and vertebral column from T12-L3 (right is 2-3cm lower)
How do you percuss for the liver?
Same pattern as palpation
The note will become dull when you reach the liver
If the liver is palpable/percussable you should confirwhere its enlarged or pushed down by hyperinflated lungs by percussing for the upper border (5th intercostal space on expiration)
Percussing for the spleen?
Same pattern as palpation
Note will go from resonant -> Dull when you find spleen
How do you check for shifting dullness?
Percus from centre of abdomen out towards left flank listening for a dull notes
When it becomes dull keep your habd there and ask patient to roll onto their right side (Toward you)#
Allow 10 seconds for fluid to shit
Then percuss again, if note has become resonance then the dullness is shifting (>1.5litres of ascites)
How do yu check for fluid thrill?
Only if the patient has a distended abdomen where the fluid is so much that it doesn’t shift
Ask patient to place side of hand parallel to body on the midline of their abdomen (to prevent impulse transmision through fat/skin)
Place one hand on their flank and flick the other side of the their abdomen, if you can feel the thrill they have a large ascites
