OSCE 5: Abdominal Exam Flashcards
What are the steps for a proper abdominal exam?
Inspection
Auscultation
Percussion
Palpation
What is Cullen sign?
Ecchymosis around umbilicus secondary to hemorrhage
What is Grey Turner sign?
Flank ecchymosis secondary to hemorrhage
What are normal bowel sounds?
5-34 clicks or gurgles per minute
What are abnormal bowel sounds?
High pitched
-decreased/absent
What arteries should be auscultated for bruits?
Abdominal aorta
Iliac arteries
Renal arteries
Femoral arteries
What type of percussion is heard in the majority of the abdomen?
Tympany
-air filled viscera
What type of percussion is heard over solid organs
Dullness
- liver
- spleen
Where is the liver normally percussed?
6-12 cm at the mid-clavicular line (right)
Where is the spleen normally percussed?
Ribs 6-10 at mid-axillary line (left)
What does rebound tenderness?
Pain upon removal of pressure rather than application of pressure to abdomen
What does rebound tenderness indicate?
Peritoneal inflammation
What is guarding?
Voluntary tightening of abdominal muscles secondary to pain
What is rigidity?
Hard, involuntary reflex contraction of abdominal wall
Where is McBurney’s point?
Point over right side of the abdomen that is ⅓ distance from ASIS to umbilicus
-roughly corresponds to appendix where it is attached to the cecum
What does rebound tenderness over McBurney’s point indicate?
Appendicitis
Peritoneal irritation
What is Rovsing’s Sign?
Pain in RLQ upon palpation in LLQ
-indicates possible appendicitis
What is the Iliopsoas Muscle test?
Patient flexes hip against resistance.
-increased abdominal pain is a positive test for inflammation of appendix
What is the Obturator Muscle test?
Flex patient’s right thigh at hip, knee bent, and rotate leg internally
-right hypogastric pain positive for appendix inflammation
What is the heel strike test?
Strike patient’s heel while supine
-abdominal pain can indicate appendicitis or peritonitis
What are ascites?
Accumulation of fluid in the peritoneal cavity, causing abdominal swelling
How do you test for ascites?
Tap flank sharply and see if impulse is transmitted to another flank
What is Murphy’s Sign?
Palpate deeply under right costal margin during inspiration
-pain can indicate acute cholecystitis or cholelithiasis
What is Courvoisier’s Sign?
Enlarged non-tender gallbladder
-can indicate pancreatic disease or cancer
What is Lloyd Punch/CVA Tenderness?
Tap the area in the back that overlies kidneys
-pain can indicate kidney infection, pyelonephritis, or renal stone
