Module 8: Abdominal Examination

Question 1

(T/F) You should always help patients into the next position, even if they don’t have trouble moving

Answer 1

True

Question 2

Always stand on the patient’s ____ side so you can easily remember which side a lesion or other issue

Answer 2

Right

Question 3

Auscultation

Answer 3

• Always before palpation -> allows for proper assessment of bowel sounds
• All 4 quadrants should be assessed -> RUQ, LUQ, RLQ, LLQ

Question 4

Bowel Sounds

Answer 4

• Sounds created as a result from peristalsis
• Contents of the bowel are being moved through the alimentary tract
• This makes intermittent clicks & gurgles

Question 5

Normal Frequency of Bowel Sounds

Answer 5

5-34 per minute

Question 6

Borborygmus

Answer 6

• Rumbling & gurgling sound of air passage through the fluids of the large bowel
• Part of everyday sounds of healthy bowel function

Question 7

Hypoactive Bowel Sounds

Answer 7

• Less than 5 sounds per minute
• Continue auscultation for up to 2 minutes
• Found in ileus, paralysis of the bowel, and peritonitis

Question 8

Hyperactive Bowel Sounds

Answer 8

• Greater than 34 sounds per minute
• May be from irritation, infection, or inflammation of bowel
• Hyperactive, high-pitched, or tinkling sounds happen w/ bowel obstruction

Question 9

If there is not narrowing of abdominal vessels

Answer 9

Flow of blood should be silent

Question 10

If turbulent flow is heard in the abdomen, it could be…

Answer 10

• A bruit
• Atherosclerosis
• Narrowing of abdominal vessels

Question 11

Hepatic/Venous Hum

Answer 11

A continuous low-grade humming associated with increased circulation between the portal and venous vessels -> Sign of cirrhosis of the liver

Question 12

Patients w/ possible peritonitis friction rub/grating/rasping sounds that are audible in the upper abdomen indicates

Answer 12

• Inflammation of the peritoneum

- Could be from a tumor, infection, abscess, or splenic infarct

Question 13

Hepatomegaly

Answer 13

• Enlargement of the liver

- Could be caused by infections (EBV, viral hepatitis), cancers, early cirrhosis, fatty infiltration, and alcohol abuse

Question 14

Splenomegaly

Answer 14

• Enlargement of the spleen

- Caused by conditions that result in increased functioning of the spleen

Question 15

Kidney Catch

Answer 15

Technique for assessment of the size of the kidney

Question 16

Abdominal Aortic Aneurysm (AAA)

Answer 16

• Dilation & enlargement of the abdominal aorta beyond approximately 2 cm
• Most commonly due to atherosclerotic disease

Question 17

If patient has abdominal pain, provider should…

Answer 17

Complete as much of the exam as possible w/ causing the least amount of pain

Question 18

If patient has abdominal pain, ask patient to locate where the pain is the most intense, the provider should start the palpation

Answer 18

With the quadrant diagonally from the area

Question 19

Normal liver span is approximately

Answer 19

6-12 cm in the midclavicular line (MCL)

Question 20

Liver span that is smaller than 6 cm may indicate

Answer 20

Cirrhosis

Question 21

Liver span that is larger than 12 cm may indicate

Answer 21

Hepatomegaly, as can be seen w/ acute hepatitis

Question 22

(T/F) A normal bladder, even in the full state, is not typically palpable/percussible

Answer 22

True

Question 23

Acute Abdomen

Answer 23

• A sudden onset of pain, typically within the prior 24 hours
• Often used synonymously with peritonitis & a ruptured viscous such as appendicitis, gallbladder, ulcer, or diverticulum

Question 24

Rigidity

Answer 24

• Sign of acute peritonitis on physical examination
• The abdominal muscles are board like due to severe irritation of the peritoneum
• May be hot to the touch
• Patient may flex into the fetal position to decrease stretching of the abdominal wall

Question 25

Rebound Tenderness

Answer 25

• Sign of acute peritonitis on physical examination
• The provider compares pain experienced by the patient with deep palpation of the abdomen versus pain experienced with the sudden lifting of the hand off the abdomen from a depressed position
• Increased pain with lifting suggests acute peritonitis

Question 26

Appendicitis

Answer 26

Inflammation of the appendix

Question 27

Examination of appendicitis is performed by palpation of the

Answer 27

Right lower quadrant

Question 28

If the patient has RLQ pain and appendicitis is in the differential, the examiner should look for

Answer 28

Rovsing’s sign

Question 29

Rovsing’s sign

Answer 29

• The provider presses slowly but firmly down on the LLQ, asking the patient if it causes or worsens the RLQ pain
• If so, this is a positive Rovsing’s sign and increases the probability of appendicitis

Question 30

Psoas Sign

Answer 30

• A patient presents with RLQ abdominal pain where the provider resists attempted flexion at the hip by the patient
• This causes the iliopsoas muscle group to contract, moving the inflamed sheath and causing pain if the appendix is in a retrocecal position

Question 31

Cholecystitis

Answer 31

Inflammation of the gallbladder

Question 32

Ascites

Answer 32

Accumulation of fluid in the abdominal cavity

Question 33

What are the 2 tests to discern abdominal ascites?

Answer 33

• Fluid Wave

- Shifting Dullness

Question 34

Lloyd’s Punch

Answer 34

• Used to assess for costovertebral angle (CVA) tenderness

- Can be intensely painful if performed too aggressively