PHYSICAL EXAMINATION OF THE ABDOMEN Flashcards
What is performed as part of the comprehensive physical examination or when a patient presents with signs or symptoms of an abdominalthoracic, thoracic, or genitourinary disease process?
Abdominal Examination
What is the sequence of exams for the abdominal exam?
- Inspection
- Auscultation
- Percussion
- Palpation
What do additional procedures detect with the abdominal exam?
abdominal pathology
What should be asked for abdominal pain?
- onset
- location
- characteristics
When indigestion occurs, patients should be questioned about what?
- character of discomfort
- location of pain
- any pain associated with food ingestion
- onset of symptoms
- treatment response
The character as well as the relationship to factors such as eating, diarrhea, pain, or medications should be determined with what on the abdominal exam?
Nausea and vomiting
Is travel history important for a patient with diarrhea in an abdominal exam?
Yes
Changes in dietary habits, medications, character of the stool, and the pattern of passing stool are important questions to ask with what?
Constipation
What are important questions when concerning fecal incontinence?
- Character of the stool
- use of laxatives
- presence of underlying disease
What are some important questions to ask a patient with jaundice?
- duration of color
- color of stools
- abdominal pain
- medications
- exposure to hepatitis
True or False
Questions should be asked about the character of dysuria (e.g., pain or volume changes) and exposure to contributing factors (e.g., tuberculosis or infection).
True
These are important questions for what?
- Changes in usual urination pattern or volume, dribbling, and characteristics of current problem should be noted
- Examiner should also record any associated factors (coughing and nocturia) as well as medications taken
Urinary frequency or incontinence
Could ingestion of red food dyes caused the false appearance of hematuria?
Yes
What is some relevant data to be considered in a patients past medical history
- Past GI disorders
- Liver problems
- History of abdominal surgery
- Abdominal or urinary tract injuries
- UTI’s
- Major illnesses
- operations
- Transfusions
- Meds
Periodic peritonitis, gallbladder or kidney disease, malabsorption syndrome, Hirschsprung disease, polyposis, or colon cancer are pieces of important data in concerns of what?
Family history of GI diseases
What is some relevant data from the personal and social history of patients for abdominal exams?
- Nutritional habits
- first/last day of menses
- physical/emotional stress
- drugs/alcohol
- exposure to disease
- Trauma
Should patients have an empty bladder during an abdominal exam?
Yes
What position should the patient be in for an abdominal exam?
supine
Inspection
Taking a deep breath does what?
Lowers the diaphragm
Inspection
Having the patient raise their head off the table does what?
Contracts the rectus abdominis muscles
Inspection
When the head is raised it will caused the rectus abdominis to contract or show signs of separation indicative of what?
- Diastasis recti
- Hernias
- Certain masses
Visible intestinal peristalsis may indicate what?
Intestinal obstruction
- Males: abdominal movement
- Females: costal movement
Bluish periumbilical discoloration, also known as Cullen sign, suggests what?
Intraabdominal bleeding
Bluish flank discoloration, also known as Gray-Turner sign, suggests what?
Retroperitoneal or Intraabdominal bleeding
Purplish striae on the abdomen are indicative of what?
Cushing’s Disease
Striae of recent origin are pink or blue but turn silvery gray/white over time.
What refers to the manifestation of excessive corticosteroids within a patient with unique physical characteristics such as striae on the abdomen, “moon face” or a “buffalo hump”?
Cushing Disease/Syndrome
Swelling or bulging at the umbilicus may indicate what?
Hernia
True or False
Asymmetrical distention seen on inspection may not be diagnostically important
False
Asymmetrical distention seen on inspection may indicate hernia, tumors, cysts, bowel obstruction, or enlargement of abdominal organs.
What is the next step in the abdominal exam after inspection?
Auscultation
Bowel sounds are heard as clicks and gurgles that occur irregularly and range from __ to __ per minute
5-35 per minute
How long must you auscultate the abdomen to be able to document absent bowel sounds?
5 minutes
True or False
Bowel sounds can be assessed most often by listening in one place; however, auscultate in all 4 quadrants if you have any concern
True
What is known as loud prolonged gurgles in bowel sounds?
Borborygmi
What are some causes for increased bowel sounds?
- Gastroenteritis
- Early intestinal obstructions
- Hunger
High pitched tinkling bowel sounds suggests what?
Intestinal fluid and air under pressure, as in early obstruction
What are soft, low pitched, continuous sounds occurring with increased collateral circulation between the portal and systemic venous systems in the epigastric region and around the umbilicus?
Venous hums
What may reflect blood flow turbulence and indicate vascular disease?
Bruits
Listen at aortic, renal, iliac, and femoral arteries
What gives you a sense of overall tympany and dullness with a abdominal exam?
Percussion
True or False
With percussion you should examine tender/painful areas first
False
How can you determine the lower border of the liver with percussion?
Start at the level of the umbilicus and percuss upward along the midclavicular line
How do you determine the upper border of the liver with percussion?
Start at the nipple line and percuss downward along the midclavicular line
How do you determine splenic borders and contour with percussion?
Percuss the spleen just posterior to the midaxillary line on the left side at the inferior costal border
True or False
You may hear a small area of splenic dullness from the 6th - 10th rib
True
During an abdominal exam where do you percuss the kidneys ?
Over the costovertebral angles
What is known as an excessive intraabdominal fluid build-up?
Ascites
True or False
When palpating the abdomen you do overall deep palpation first and then light palpation
False
Do overall light palpation, then deep palpation
When palpating the epigastric area for aortic pulsation, what would a prominent lateral pulsation be indicative of?
Aortic aneurysm
What is a palpation technique used to assess floating masses?
Ballottement
What special test is this?
Assess by pressing gently and deeply into a region remote from the area of discomfort. Rapidly withdraw your hand. A positive test is elicited if the removal of your hand causes a sharp stabbing pain at the site of peritoneal inflammation (positive Blumberg sign).
Rebound tenderness
Rebound tenderness over Mcburney’s point in the right lower quadrant (positive Mcburney’s sign) suggests what?
Appendicitis
What special tests assesses for peritoneal irritation?
Markle (heel jar) test
You assess for Rovsing sign when concerned for what?
Appendicitis
What is a positive Rovsing sign?
A positive test is increased right lower quadrant pain with palpation of the left lower quadrant.
What special test is this?
Have the patient lie supine and place your hand over the lower right thigh. Have the patient raise the right leg while you push downward. Abdominal pain with this motion is considered a positive “psoas sign”.
Iliopsoas muscle test.
True or False
You conduct the Iliopsoas test when you suspect an inflamed gallbladder
False
Conduct the Iliopsoas muscle test when you suspect appendicitis.
You would conduct an Obturator muscle test when you suspect what?
Appendicitis or pelvic abscess
What special test is this?
With the patient in a supine position, flex the patient’s right hip and knee to 90 degrees. Hold the leg just above the knee, grasp the ankle, and rotate the leg laterally and medially. Abdominal pain with this motion is a positive sign.
Obturator Muscle Test
What special test do you use to asses for gallbladder irritation or inflammation?
Murphy’s sign
What special test is this?
Place hands at the inferior costal margin in the right upper quadrant. Have the patient take a deep breath in while keeping your hands in place. Abrupt cessation of inspiration on palpation of the gallbladder means this sign is
present and is suggestive of cholecystitis
Murphy’s sign
How long do bowel sounds range from?
5 - 35 per minute
True or False
Liver span is greater in males and tall persons
True
What does Cullen sign suggest?
Intraabdominal bleeding
What does Gray-Turner sign suggest?
Retroperitoneal or intraabdominal bleeding
Purplish striae results from what?
Cushing’s disease
A pearl like umbilical node suggests what?
Intraabdominal lymphoma
Scarring from previous abdominal surgeries could be suggestive of what?
possible internal adhesions
