Module 8: Abdominal Examination Flashcards
(T/F) You should always help patients into the next position, even if they don’t have trouble moving
True
Always stand on the patient’s ____ side so you can easily remember which side a lesion or other issue
Right
Auscultation
- Always before palpation -> allows for proper assessment of bowel sounds
- All 4 quadrants should be assessed -> RUQ, LUQ, RLQ, LLQ
Bowel Sounds
- Sounds created as a result from peristalsis
- Contents of the bowel are being moved through the alimentary tract
- This makes intermittent clicks & gurgles
Normal Frequency of Bowel Sounds
5-34 per minute
Borborygmus
- Rumbling & gurgling sound of air passage through the fluids of the large bowel
- Part of everyday sounds of healthy bowel function
Hypoactive Bowel Sounds
- Less than 5 sounds per minute
- Continue auscultation for up to 2 minutes
- Found in ileus, paralysis of the bowel, and peritonitis
Hyperactive Bowel Sounds
- 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
If there is not narrowing of abdominal vessels
Flow of blood should be silent
If turbulent flow is heard in the abdomen, it could be…
- A bruit
- Atherosclerosis
- Narrowing of abdominal vessels
Hepatic/Venous Hum
A continuous low-grade humming associated with increased circulation between the portal and venous vessels -> Sign of cirrhosis of the liver
Patients w/ possible peritonitis friction rub/grating/rasping sounds that are audible in the upper abdomen indicates
- Inflammation of the peritoneum
- Could be from a tumor, infection, abscess, or splenic infarct
Hepatomegaly
- Enlargement of the liver
- Could be caused by infections (EBV, viral hepatitis), cancers, early cirrhosis, fatty infiltration, and alcohol abuse
Splenomegaly
- Enlargement of the spleen
- Caused by conditions that result in increased functioning of the spleen
Kidney Catch
Technique for assessment of the size of the kidney
Abdominal Aortic Aneurysm (AAA)
- Dilation & enlargement of the abdominal aorta beyond approximately 2 cm
- Most commonly due to atherosclerotic disease
If patient has abdominal pain, provider should…
Complete as much of the exam as possible w/ causing the least amount of pain
If patient has abdominal pain, ask patient to locate where the pain is the most intense, the provider should start the palpation
With the quadrant diagonally from the area
Normal liver span is approximately
6-12 cm in the midclavicular line (MCL)
Liver span that is smaller than 6 cm may indicate
Cirrhosis
Liver span that is larger than 12 cm may indicate
Hepatomegaly, as can be seen w/ acute hepatitis
(T/F) A normal bladder, even in the full state, is not typically palpable/percussible
True
Acute Abdomen
- 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
Rigidity
- 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
Rebound Tenderness
- 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
Appendicitis
Inflammation of the appendix
Examination of appendicitis is performed by palpation of the
Right lower quadrant
If the patient has RLQ pain and appendicitis is in the differential, the examiner should look for
Rovsing’s sign
Rovsing’s sign
- 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
Psoas Sign
- 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
Cholecystitis
Inflammation of the gallbladder
Ascites
Accumulation of fluid in the abdominal cavity
What are the 2 tests to discern abdominal ascites?
- Fluid Wave
- Shifting Dullness
Lloyd’s Punch
- Used to assess for costovertebral angle (CVA) tenderness
- Can be intensely painful if performed too aggressively
