Intro to abdominal exam Flashcards
What are some general considerations to have for your patient?
- Empty bladder
- Ask about areas if pain; if yes, do that area last
- If pt is ticklish put your hand on top of theirs
What 8 major findings should be inspected for?
Scar
herniations
abdomen contour
peristalsis
pulsations
everted umbilicus
cullen’s sign
grey turner’s sign
What is the concern about scars/past abdominal surgery?
adhesions may develop and are associated with small bowel obstruction
How can a hernia be pronounced and what are 4 types?
lifting head off of exam table
umbilical
incisional
epigastric
diastasis recti
In what cases may the contour of the abdomen be rounded/concave?
fat
tumor
pregnancy
ascites
Why should the contour of the flanks be inspected
ascites will be found there when the patient is supine
What may cause the contour of the abdomen to be asymmetrical?
enlargement of an organ or a mass
What would peristalsis on inspection of the abdomen indicate?
early intestinal obstruction
What may visible pulsation in the abdomen on inspection suggest?
Aneurysm
abdominal pain
hypotension
pulsatile mass
What may an inverted umbilicus indicate?
free fluid in the abdominal cavity
What are cullen’s sign and grey turner’s sign indicative of and what may cause it?
retroperitoneal hemorrhage
hemorrhagic pancreatitis
abdominal aortic aneurysm rupture
What are varicose veins of the abdomen called and what do they indicate?
Caput medusae
disruption of hepatic portal system (portal HTN)
How frequent are bowel sounds
5-34 per minute
What may alter bowel sounds?
diarrhea
obstruction
-hyperactive early, then diminished, then absent
paralytic ileus
peritonitis
What is borborygmi?
audible abdominal sound produced by hyperactive peristalsis
What, in addition to borborygmi, may indicate an underlying pathology?
N/V
distended abd
abd cramps
suggests SBO
How long must you listen for bowel sounds before stating none are present?
2 (3-5) minutes
What should be considered when evaluating for bruits
use the bell
do AA and renal (renal artery stenosis)
On percussion, you will hear ____ at sites of gas and ____ at sites of fluid/feces
tympany
dullness
Where is the liver found?
RMCL
distance 6-12 cm
Where is the spleen found?
10 ICS AAL
How should it sound when percussing the spleen
tympanic through deep inhalation
Where is the gastric air bubble typically found?
epigastric to LUQ
What indicates a full bladder?
dullness to percussion at the suprapubic area
How to do light palpation?
*flex knees
1. watch facial expression
2. should be soft/no tenderness
3. tenderness - peritoneal inflammation
How to do deep palpation?
*flex knees
1. one hand on top of the other
2. observe facial expressions
3. feel for masses, note:
-size
-shape
-tenderness
-mobility with respiration
How to palpate the AA?
- gently
- lateral aspect of 2nd fingers
How to palpate liver?
- left hand behind ribs 11/12
- R hand lateral to rectus muscle
- have patient take deep breaths
- move hand up on expiration
- is the liver’s edge…
-soft
-sharp
-smooth
-tender
(Riedel’s lobe)
What is the most commonly injured abdominal organ?
spleen
How to palpate the spleen
- L hand under back of L ribcage
- R hand at umbilicus toward spleen
- deep inspiration
- move on expiration
How to test for CVA tenderness
ulnar surface of the fist at the spot where the 12th rib attaches to the vertebrae
What tests evaluate peritoneal irritation?
- abd pain on coughing or with light touch
- rebound tenderness (worse when let go)
- Jar sign/Markle sign
What are the special tests to evaluate for appendicitis?
- rebound tenderness
- jar sign
- abd pain with cough/light palp
- muscular rigidity/guarding
- rovsing’s sign
- referred rebound tenderness
- psoas sign
- obturator sign
- rectal exam
voluntary vs involuntary guarding
voluntary - symmetric
involuntary - may be unilateral
What 2 tests are used for cholecystitis
Murphy’s sign
courvoisiers sign
What is courvoisiers sign
gallstone blocking CBD - GB will be smaller
alternative cause (ex, cancer) - GB will be dilated/larger
What should be assess on a hernia?
reducibility
incarceration
strangulation
Describe pyloric stenosis and findings?
olive sign above umbilicus
Succussion splash
distended stomach
hx of projectile vomit followed by intense hunger
Describe the succussion splash
positive when a very loud splash due to a significant amount of fluid and air - suggests gastric dilation or gastric outlet obstruction
-auscultate over epigastric region
WNL, sounds are heard when patient moves/viscera disturbed by palpation
What is palpated in male patients during a rectal exam?
prostate gland and distal rectum and anus
What is the first step to a rectal exam
glove both hands
When should the patient be positioned lying on the left side for a rectal exam?
always except for a prostate exam in males or a when the rectal exam is done as a part of the pelvic exam in females
What position should the patient be in more a prostate exam?
standing, bending over an exam table
What should be inspected at the beginning of a rectal exam
spread buttocks and inspect sacrococcygeal and perineal areas for inflammation, rashes, or excoriation
How does asking the patient to strain while inspecting the anus help?
makes it easier to see hemorrhoids, fissures, excoriations, or abnormal growths
What should you have the patient do before inserted lubricated finger?
strain/valsalva
note sphincter tone
How should the finger be inserted?
as the patient strains, insert your fingertip into the anal canal in a direction pointing toward the umbilicus
rotate finger clockwise, then counterclockwise
Note any nodules, irregularities, or undue tenderness
What should be obtained during a rectal exam?
fecal sample
What chemical is on the test card?
guaiac resin
What should be placed on the developing side of the test card?
one or two drops of hydrogen peroxide and ethanol developer
What will happen if the occult blood test is positive?
the specimen will turn blue within 30-60 seconds
What should the color of the stool sample be compared to?
performance control area
Always use history/subjective information to consider?
false positive occult blood test
