OSCE: ABD Exam Flashcards
What are the 4 steps to an ABD exam?
inspection, auscultation, percussion, palpation
What is Cullen sign and Grey Turner sign?
Cullen sign: periumbilical ecchymosis secondary to hemorrhage
Grey Turner sign: flank ecchymosis secondary to hemorrhage
Which part of the stethoscope do you use to listen to bowel sounds? What is normal vs abnormal?
diaphragm of the stethoscope
Normal: 5-34 clicks/gurgles per minute
Abnormal: high pitched, decreased/absent
Which part of the stethoscope do you use to list for ABD vascular sounds? Which arteries should you listen to?
bell of stethoscope (for bruits)
ABD aorta, iliac As., renal As. and femoral As.
What 2 things can you hear when you percuss the ABD? What does each mean?
Tympany: found in majority of ABD due to air-filled viscera
Dullness: flat sound heard over solid organs (liver/spleen), fluid in the peritoneum or feces
What is the expected liver span?
6-12 cm at the mid-clavicular line on the right
What is the expected spleen span?
from ribs 6-10 at the mid-axillary line on the left
Explain differences between light, moderate, and deep palpation
Light: use tips of fingers to lightly touch skin; up to 1cm
Moderate: use fingers or sides of hands to lightly touch skin, 2-3 cm
Deep: use fingers and palms to palpate more than 3 cm
What is rebound tenderness?
pain upon removal of pressure -> indicates peritoneal inflammation
What is guarding?
voluntary tightening of ABD muscles secondary to pain
What is rigidity?
ABD is hard, involuntary reflex contraction of ABD wall
Describe visceral pain
secondary to distention, stretching or contracting; usually felt in midline at level of structure involved; not localized
Describe parietal (somatic) pain
secondary to inflammation in parietal peritoneum; usually constant and more severe; localized; aggravated by movement or coughing; alleviated by remaining still
What is McBurney’s point? What does it indicate?
rebound tenderness or pain 1/3 of the distance from ASIS to umbilicus
Indicates: possible appendicitis/peritoneal irritation
What is Rovsing’s Sign? What does it indicate?
pain in the RLQ while palpating the LLQ
Indicates: possible appendicitis
What is the Iliopsoas Muscle Test? What does it indicate?
have pt flex their hip against resistance; positive test is increased ABD pain
Indicates: irritation of psoas muscle from inflammation of appendix
What is the Obturator Muscle Test? What does it indicate?
flex pt’s right thigh at hip w/ knee bent and internally rotate hip; right hypogastric pain is positive
Indicates: irritation of obturator muscle from inflammation of appendix
What is the Heel Strike? What does it indicate?
w/ pt supine, strike pt’s heel; positive test is ABD pain
Indicates: possible appendicitis or peritonitis
How should you palpate the liver?
- place left hand behind pt’s back to support 11th and 12th ribs and lightly press anterior
- place right hand just below costal margin in mid-clavicular line w/ fingers pointing cephalad; gently press in and up w/ fingertips (palpate liver edge during inhalation)
What is the alternative “hooking technique” for liver palpation?
stand to right of pt’s chest and place both hands side-by-side w/ fingertip along right costal margin. press in and up w/ fingertips (palpate liver edge during inhalation)
What is Murphy’s sign? What does it indicate?
palpate deeply under right costal margin during inspiration; positive is pain and/or sudden stop in inspiratory effort
Indicates: acute cholecystitis or cholelithasis
What is Courviosier’s Sign? What does it indicate?
enlarged non-tender gallbladder
Indicates: pancreatic disease/cancer
How do you palpate for the spleen? What should you find?
- place left hand under rib cage and press forward for support
- place right hand below left costal margin and gently press inward
- normal spleen should NOT be palpable
How do you palpate the kidneys?
- place cephalad hand behind pt, just below and parallel to 12th rib, press anteriorly
- place caudal hand just below costal margin in RUQ/LUQ, press down firmly and deeply at peak of pt’s inspiration
What is Lloyd’s Punch/Costovertebral Angle (CVA) Tenderness? What does it indicate?
gently tap area of back overlying kidney (costovertebral angles); positive is pain
Indicates: infection around kidney (perinephric abscess), pyelonephritis, or kidney stone
How do you palpate the aorta? What is normal vs abnormal?
- just above the umbilicus slightly to the left of midline
- estimate width of aorta
- Normal: 2-3 cm width, pulsation in an anterior-inferior direction
Abnormal: >3cm win width w/ prominent lateral pulsation
