Normal Abdominal Exam (LAB) Flashcards
In which order do you conduct an abdominal exam?
- Inspection
- Auscultation
- Percussion
- Palpation
Differentiate between Grey Turner and Cullen Sign.
Grey Turner: Flank ecchymosis secondary to hemorrhage
Cullen: Ecchymosis around the umbilicus (periumbilical) secondary to hemorrhage
Differentiate between normal and abnormal bowel sounds.
Normal: 5-34 Gurgles per minute
Abnormal: HIGH pitched, Decreased or Absent
What are you listening for when you focus in on Vascular Sound in the abdomen? Which part of the stethoscope would you use?
Abdominal Aorta, Iliac, Renal and Femoral Arteries
Listen for Bruit with the BELL of the Stethoscope
Differentiate between Tympany and Dullness sounds when Percussion.
Tympany: Air-Filled viscera
Dullness: Flat sound without echos, heard over solid organs. LIVER and SPLEEN, fluid in the peritoneum or feces give a dull note
What is the expected liver size?
6-12 cm at the mid-clavicular line on the right
What is the expected size of the spleen?
Ribs 6-10 at the Mid-Axillary line on the left
What are some general considerations to thin about before palpating the Abdomen?
- Warm Hands
- Bend patient’s knees to relax the Abdominal Muscles
- Examine MOST tender areas LAST
Differentiate between Light, Moderate, and Deep Palpation.
Light: 1 cm in depth, use the tips of fingers
Moderate: 2-3 cm in depth, use fingers or side of hand
Deep: More than 3 cm in depth, use fingers and palmar surface of the hand
What are some signs to look for during a Deep palpation exam of the Abdomen?
Rebound Tenderness: Pain upon removal of pressure, rather than the application of pressure to the abdomen (Tests for PERITONEAL INFLAMMATION)
Guarding: Voluntary vs. Involuntary
Rigidity: Involuntary contraction of abdominal wall
Rovsing’s Sign: Pain in the RLQ during left-sided pressure; Referred rebound tenderness seen in APPENDICITIS
McBurney’s Point: Rebound tenderness or pain 1/3 of the distance from the ASIS to the umbilicus; May suggest APPENDICITIS/Peritoneal Irritation
How do you palpate the liver?
- Place Left hand behind the patient’s back supporting rib 11 and 12
- Place right hand just below costal margin in the mid-clavicular line
- Gentle press IN and UP
How do you palpate the gallbladder?
Murphy Sign: Palpate deeply under right costal margin during inspiration and observe for pain and/or sudden STOP in INSPIRATORY effort (Tests for Acute CHOLECYSTITIS or Cholelithiasis)
Courvoisier’s Sign: Enlarged non-tender gallbladder secondary to PANCREATIC disease or cancer
Should a normal spleen be palpable?
NO
How do you palpate for the aorta?
- Just above the umbilicus, left of midline
- Estimated width of Aorta is 2-3 cm
- EXPECTED: Pulsation in an anterior-inferior direction
- UNEXPECTED: Prominent LATERAL pulsation and more than 3 cm in diameter
List the Sympathetic Spinal levels for the different organs in the Abdomen.
- Esophagus: T2-8
- Stomach: T5-9
- Gallbladder: T6-9
- Small Intestine: T9-11
- Colon: T10-L2
- Pancreas: T5-11
- Appendix: T12
