PE - abdomen (partial)

Question 1

These steps are done to ensure that the abdominal wall musculature is relax

Answer 1

1. The head and knees should be supported with small pillows or folded sheets
2. The patient’s arms should be at the sides and not folded behind the head, as this tenses the abdominal wall

Question 2

The techniques of physical examination of the abdomen proceed in the following order:

Answer 2

1. INSPECTION
2. AUSCULTATION
3. PERCUSSION
4. PALPATION
   * *This is in contrast to that of the physical examination of the chest and lungs (which proceeds in the order of inspection, palpation, percussion, and auscultation).
   * * This is to prevent manipulation of the abdomen with palpation and percussion that may stimulate peristalsis and thereby alter your examination findings

Question 3

May be indicative of severe malnutrition or cachexia

Answer 3

A scaphoid abdomen

Question 4

Indicates distention due to the 5 F’s (fat, flatus, fetus, fluid, feces) and tumors

Answer 4

A protuberant abdomen

Question 5

The abdominal wall skin should be inspected carefully for abnormalities: areas of discoloration, striae, or “stretch marks,” and surgical scars, engorged veins in the abdominal wall or spider angiomas
Normal findings:
Abnormal Findings:

Answer 5

Normal findings:
(-) discoloration, hyperpigmentation
(-) striae, scars, dilated veins
*Old silver striae or stretch marks are normal

Abnormal Findings:
Bluish discoloration of the umbilicus (Cullen’s sign) or flanks (Grey Turner’s sign)
Pink-purple striae of Cushing’s syndrome
Dilated veins of hepatic cirrhosis or of Inferior Vena Cava (IVC) obstruction (Caput Medusae)

Question 6

The abdominal wall should be observed for motion with respiration
Normal findings:
Abnormal findings:

Answer 6

Normal findings: Moves posteriorly in symmetry with inspiration

Abnormal findings: In peritonitis, there may be localized or generalized rigidity of the abdominal wall so that symmetrical motion of the abdomen with respiration is absent

Question 7

When bowel sounds are not present, one should listen for how many minutes before determining that bowel sounds are, in fact, absent?

Answer 7

3 minutes

Question 8

Long prolonged gurgles of hyperperistalsis (“stomach growling”) which is normal

Answer 8

Borborygmi

Question 9

Normoactive bowel sounds, approximately 12 per minute are heard at what quadrant?

Answer 9

RLQ

* *Normal: 5 – 34 bowel sounds per minute

Question 10

Hyperactive bowel sounds are heard in what conditions?

Answer 10

Intestinal obstruction and diarrhea

Question 11

Hypoactive bowel sounds are heard in what conditions?

Answer 11

Paralytic ileus and peritonitis

Question 12

“swishing” sounds heard over major arteries during systole or, less commonly, systole and diastole. The area over the aorta, both renal arteries, and the iliac arteries should be examined carefully

Answer 12

Bruits

Question 13

Bruits suggest what conditions?

Answer 13

Abdominal aortic stenosis or aneurysm

* *Epigastric bruits confined to systole may be normal

Question 14

Indicate inflammation of the peritoneal surface of an organ

Answer 14

Friction rubs

Question 15

A protuberant abdomen that is tympanitic suggests what condition?

Answer 15

Intestinal obstruction

Question 16

This will demonstrate the crunching feeling of crepitus of the abdominal wall. In addition, it will demonstrate any irregularities of the abdominal wall (such as lipomas or hernias) and give some idea as to areas of tenderness

Answer 16

Gently examining the abdominal wall with the fingertips

Question 17

How is deep palpation of the abdomen performed?

Answer 17

Placing the flat of the hand on the abdominal wall and applying firm, steady pressure. It may be helpful to use two-handed palpation particularly in evaluating a mass. Here the upper hand is used to exert pressure, while the lower hand is used to feel. One should start deep palpation in the quadrant directly opposite any area of pain and carefully examine each quadrant. At each costal margin it is helpful to have the patient inspire deeply to aid in palpation of the liver, gallbladder, and spleen

Question 18

The objective expression of pain from palpation

Answer 18

Abdominal tenderness

Question 19

Tenderness that is elicited upon direct palpation of the abdomen

Answer 19

Direct tenderness

Question 20

Tenderness that is elicited upon rapid removal of the palpating hand

Answer 20

Rebound tenderness

** suggests peritoneal inflammation

Question 21

Palpation of the left lower quadrant may produce tenderness and rebound tenderness in the right lower quadrant in appendicitis

Answer 21

Rovsing’s sign

Question 22

Starting in the midclavicular line at about the 3rd intercostal space, lightly percuss and move down. Percuss inferiorly until dullness denotes the liver’s upper border. This is located approximately at what region?

Answer 22

5th ICS MCL