Normal Abdominal Exam-1/13/16

Question 1

What are you inspecting in all 4 quadrants?

Answer 1

Skin color/characteristics–> jaundice, GREY TURNER SIGN (flank ecchymosis secondary to hemorrhage), CULLEN SIGN (ecchymosis around the umbilicus secondary to hemorrhage, scars/striae, dilated veins, rashes & lesions

Contour/symmetry–> abdominal distention, hernias/masses

Surface motion –> peristalsis

Pulsations

Question 2

What part of the stethoscope do you auscultate the 4 quadrants for BOWEL SOUNDS?

Answer 2

Diaphragm–> frequency and character of bowel sounds.

Normal=5-35 clicks or gurgles per minute
Abnormal=High pitched, decreased/absent

Question 3

What part of the stethoscope do you use to listen to VASCULAR SOUNDS?

Answer 3

Bell –> abdominal aorta, iliac, renal, and femoral arteries; Listen for bruits

Question 4

This type of sound from percussing the abdomen is found in the majority of the abdomen, caused by air-filled viscera

Answer 4

Tympany

Question 5

This type of sound from percussing the abdomen is a flat sound without echoes, heard over solid organs.

Answer 5

Dullness–> liver & spleen, fluid in the peritoneum or feces give a dull note

Question 6

Where do you percuss the liver?

Answer 6

Mid-clavicular line on the right (should span 6-12 cm)

Question 7

Where do you percuss the spleen?

Answer 7

Mid-axillary line on left (should span ribs 6-10)

Question 8

Where should you palpate the abdominal aorta?

Answer 8

Left of midline, normally 2-3 cm width

Question 9

Describe REBOUND TENDERNESS

Answer 9

Pain upon removal of pressure, rather than application of pressure to abdomen. Tests for peritoneal inflammation

Question 10

What are you testing for with DEEP PALPATION?

Answer 10

Rebound tenderness
Guarding
Rigidity
Rovsing's sign
McBurney's point

Question 11

What is ROVSINGS SIGN?

Answer 11

Pain in the RLQ during left-sided pressure-referred rebound tenderness seen in appendicitis

Question 12

Where is McBurney’s point?

Answer 12

1/3 the distance from ASIS to umbilicus

May suggest appendicitis/peritoneal irritation

Question 13

Describe MURPHY’S SIGN

Answer 13

For acute cholecystitis or cholelithiasis

Palpate deeply under right costal margin during inspiration & observe for pain and/or sudden stop in inspiratory effort

Question 14

Describe COURVOISIER’S SIGN

Answer 14

Enlarged non-tender gallbladder secondary to pancreatic disease or cancer

Question 15

What are Special Tests for abdominal exam?

Answer 15

Iliopsoas Muscle test
Obturator Muscle test
Lloyd punch
Heel strike

Question 16

Describe Iliopsoas test

Answer 16

Pt flexes hip against resistance

Increased abdominal pain is a POSITIVE test–> suggests irritation of psoas muscle from inflamm. Of appendix

Question 17

Describe OBTURATOR muscle test

Answer 17

Flex pts right thigh at hip, with knee bent, and rotate leg internally at hip.

Right hypogastric pain is a POSITIVE test–> suggests irritation of obturator muscle from inflamed appendix

Question 18

Describe Lloyd punch

Answer 18

CVA tenderness

Gently tap area of back overlying kidney produces pain

Suggests infection around kidney or pyelonephritis or renal stone

Question 19

Describe Heel strike

Answer 19

Patient supine. Doc strikes patients heel. Pain upon striking could indicate appendicitis

Question 20

What is the correct order of the abdominal exam?

Answer 20

1) Inspect
2) Auscultate
3) Percuss
4) Palpate