PHYSICAL EXAMINATION OF THE ABDOMEN Flashcards
The abd exam happens in what order
Inspection Auscultation Percussion Palpation Special Tests
During the abdominal examination, careful attention should be paid to the patient’s….. or……
comfort level or degree of distress
Pertinent data include family history should include:
periodic peritonitis gallbladder or kidney disease malabsorption syndrome Hirschsprung disease polyposis colon cancer
Personal and Social History relevant data should include
include nutritional habits,
first day of last menses,
physical or emotional stress
use of alcohol or street drugs
-Exposure to infectious diseases or trauma from work or other activity should be noted.
Trauma from work or other activity should be noted, type of work, physical activity, physical or emotional abuse
True/False
The patient does not need an empty bladder for an ABD exam
FALSE
Should always have an empty bladder
Preparation and Positioning
(a) Patient should have an ____ bladder.
(b) Approach from the patient’s ____ side.
(c) Place patient in the supine position with arms at side and a small pillow under the head and knees. Knees should be _____ and feet placed flat on exam table.
(d) Ensure _____ and ______ of the patient’s abdomen. Make sure your hands are warm and your fingernails are trimmed.
(e) Drape towel over patient’s chest for ________. Help the patient feel as comfortable and relaxed as possible.
(a) Empty
(b) Right
(c) slightly flexed
(d) good lighting, Full exposure
(e) warmth and privacy
Inspection
Begin by inspecting the abdomen from a seated position on the patient’s ____ side with patient lying supine
right
True/False
Inspection
Have patient take a deep breath and hold this raises the diaphragm
False
Lowers the diaphragm
Inspection
Have patient raise his or her head off the table. This does what?
contracts the rectus abdominis muscles
True/False
Inspection
When the head is raised it will cause the rectus to contract or show signs of separation indicative of diastasis recti, hernias or certain masses.
True
Inspection
Purplish striae are indicative of
Cushing disease
____ - Refers to the manifestation of excessive corticosteroids within a patient
Cushing Disease/Syndrome
Inspection
Bluish periumbilical discoloration (Cullen sign) suggests what
intraabdominal bleeding
Inspection
Bluish flank discoloration (Gray-Turner sign) suggests what?
retroperitoneal or intraabdominal bleeding
Swelling or bulges may indicate what
Hernia
Bowel sounds are heard as clicks and gurgles that occur irregularly and range from _____ per minute, you must listen for ____ minutes to be able to document absent bowel sounds
5-35
5 minutes
Auscultation
_____ are loud prolonged gurgles
Borborygmi
Auscultation
High pitched tinkling sounds suggest
intestinal fluid and air under pressure, as in early obstruction
Auscultate
Decreased bowel sounds occur with
peritonitis and paralytic ileus
Auscultate
High pitched sounds associated with respiration are indicative of
friction rubs
Bruits can be heard with the bell (harsh or musical intermittent auscultatory sounds) may reflect blood flow turbulence and indicate vascular disease. Listen at the ………
aortic, renal, iliac, and femoral arteries
What are soft, low pitched, continuous sounds occurring with increased collateral circulation between the portal and systemic venous systems.
Venous hums
True/False
Percussion
Examine tender/painful areas first
FALSE
Last
True/False
Percussion
The gastric bubble is lower in pitch than normal tympany of the
intestine
True
Percuss the kidneys over the _______ to assess for tenderness while patient is in the sitting position.
costovertebral angle
Percussion
what is ascites?
excessive intraabdominal fluid build-up
True/False
Do overall light palpation, then deep palpation
True
Palpation
(1) Do overall _____ palpation, then ____ palpation.
(2) Assess for muscle guarding, masses, fluid, areas of tenderness, and size and shape of organs.
(3) Palpate epigastric area for aortic pulsation, if prominent lateral pulsation is felt it could be indicative to _______.
(4) Palpate umbilical area.
(5) Feel for gallbladder.
(6) Palpate for liver, spleen, kidneys.
(7) ______ is a palpation technique used to assess a floating mass.
(8) Perform bi-manual ballottement to determine the _____ and ____ of the mass
(1) Light then deep
(3) aortic aneurysm
(7) Ballottement
(8) presence and size of the mass
Special Tests
_____ is assessed by pressing gently and deeply into a region remote from the area of discomfort. Rapidly withdraw your hand.
Rebound tenderness
A ______ test is illicited if the removal of your hand causes a sharp stabbing pain at the site of peritoneal inflammation. What sign is this
Positive
positive Blumberg sign
What is a positive Blumberg sign?
sharp stabbing pain at the site of peritoneal inflammation from rebound tenderness
Special tests
Rebound tenderness over McBurney’s point in the right lower
quadrant suggests ____
appendicitis (positive McBurney’s sign).
_______ is located approximately 2 inches from the Anterior Superior Iliac Spine (ASIS) on a straight line to the umbilicus
McBurney’s Point
_______ - Assesses for peritoneal irritation. Have patient stand with straight knees, rise up on the toes, then relax and allow heels to hit the floor.
Markle (heel jar) test
True/False
Markle (heel jar) test
The test is positive if abdominal pain does not occur with this action
FALSE
Pain does occur
Conduct ______test when you suspect appendicitis. 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
Assess for gallbladder irritation or inflammation via ____
Murphy’s sign
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 _____ is present and is suggestive of _______
Murphy’s sign
cholecystitis
Pick one
Normal/Typical Variation/Finding associated with disorder
(1) Contralateral areas are symmetric with a deep breath.
(2) Contour smooth and symmetric.
(3) Bowel sounds range from 5 to 35 per minute.
(4) Dullness is heard when percussing over organs. Liver dullness is heard at costal margin or just below it. Splenic dullness is heard from the sixth to the tenth rib.
(5) Umbilicus is free from bulges, nodules, and granulation.
Normal
Pick one
Normal/Typical Variation/Finding associated with disorder
(1) Scaphoid or concave contour is seen in thin adults.
(2) Rounded or convex abdomen is the result of subcutaneous fat or poor muscle tone.
(3) Umbilicus may be inverted or may protrude slightly.
(4) Pulsations may be visible in thin persons.
(5) Aortic pulse may be felt in thin persons.
(6) Liver span is greater in males and tall persons.
(7) Full stomach and intestinal feces mimic dullness of splenic enlargement.
(8) Muscles, arteries, and feces mimic abdominal masses.
Typical Variation
Jaundice, cyanosis, and ascites are signs of
physiologic problems
Cullen sign suggests
intraabdominal bleeding
Gray-Turner sign suggests
retroperitoneal or intraabdominal bleeding
Purplish striae result from
Cushing’s disease
A pearl-like umbilical node suggests
intraabdominal lymphoma
Scarring (from previous abdominal surgery) is associated with
internal adhesions
______ is caused by obesity, enlarged organs, fluid, or gas
Distention
______ iscaused by increased portal and systemic circulation
Venous hum
Rigidity occurs over _______
peritoneal irritation
Murphy sign (abrupt cessation of inspiration on palpation of gallbladder) occurs with…..
inflamed gallbladder
Rebound tenderness over McBurney’s point suggests
appendicitis
