Abdomen Examination Flashcards
(20 cards)
Primary system examination of Abdomen
• Inspection
• Auscultation
• Palpation
• Light palpation
• deep palpation
• Palpation of liver
• Palpation of spleen
• Percussion
Additional examinations of Abdomen
• Liver span
• Percussion of spleen
• Shifting dullness test for Ascites
• Fluid wave test for Ascites
Right Upper Quadrant
(RUQ)
• Gall bladder
• Duodenum
• Head of pancreas
• (R) kidney/ adrenal
• Hepatic flexure colon
• Part of ascending &
transverse colon
Left Upper Quadrant
(LUQ)
• Stomach
• Spleen
• (L) lobe liver
• Body of pancreas
• (L) kidney/ adrenal
• Splenic flexure colon
• Part of transverse &
descending colon
Right Lower Quadrant
(RLQ)
• Caecum
• Appendix
• (R) ovary & tube
• (R) ureter
• (R) spermatic cord
Left Lower Quadrant
(LLQ)
• Parts of descending
colon
• Sigmoid colon
• (L) ovary& tube
• (L) ureter
• (L) spermatic cord
Midline
• Aorta
• Uterus
• Bladder
• Rectum
Inspection of the Abdomen
Contour and Shape
- Rounded, Scaphoid, Protuberant, Flat
- Bulging flanks might indicate ascites
Umbilicus
- shape and position (typical midline inverted), discolouration, inflammation, piercings, hernia
Skin
- colour, appearance, striae, moles, lesions, scars, blood vessels (spider naevi or caput madusa), turgor
Symmetry
- use pen light
Pulsations and other movement
- pulsations from aorta, respiratory, peristalsis
Hair distribution
- LOOK and ASK changes in amount, courseness, distribution
Demeanour
- comfortable, still, relaxed
- restless, knee bending, foetal position (colic, gastroenteritis, bowel obstruction)
- rigid, knees bent, shallow breathing, reluctance, to move (peritonitis)
Auscultation of Abdomen
• Normal bowel sounds
- irregular, high-pitched, gurgling, cascading sounds, about 5-30 times per minute.
• Hyperactive bowel sounds
- loud, high-pitched, rushing and
indicating increased motility.
Borboygmus is the hyperactive
bowel sound commonly heard as
the ‘stomach growling’ from
hyperperistalsis.
• Less than 5 bowel sounds per
minute could indicate hypoactive
bowels. Absence of any sounds
for 5 minutes, could indicate
inactive or obstructed bowels.
Percussion of the Abdomen
Assess relative density of abdominal contents and screen for abnormal fluid or masses.
Light percussion in all four quadrants to
determine prevailing amount of tympany and dullness.
• Tympany predominates on percussion because air in the intestines rises
to the surface when the person is supine.
• A dullness would indicate fluid, mass, presence of fat or a solid organ
Palpation of Abdomen
• assess size, location, and
consistency of certain organs; to screen for an abnormal mass or tenderness.
• Light and Deep Palpation of abdomen is performed followed by liver and
spleen palpation.
• Additional measures should be taken to enhance complete muscle relaxation while palpating abdomen.
Light palpation of the abdomen
• helps to form overall impression of abdomen, should be warm and relaxed, patient should be comfortable and pain free.
• Mild tenderness normally present when palpating the sigmoid colon in
left lower quadrant.
Any other tenderness should be investigated.
• Voluntary muscle guarding may be present when client is cold/ tense/
ticklish. Involuntary rigidity indicates acute peritoneal inflammation.
Deep palpation of the abdomen
• Deep palpation used to determine size and location of organs and
masses.
While palpating abdomen visualize normal underlying structures
in each quadrant and If a mass is felt on palpation, first distinguish it from
a normally palpable structure or an enlarged organ.
Liver Palpation
• determine if enlarged, ascertain the
texture
• Place left hand under back to support abdomen at 11th and 12th rib.
Ask person to breath in as you push in to palpate liver with your right hand.
Diaphragm pushes the liver down as we inhale.
Should feel a firm, regular edge of the liver bump your fingertips.
Normal not to be able to palpate the edge of the liver in some people.
Clinical significance
Enlargement or a nodular border or pain on palpation suggests liver
disease or dysfunction e.g. Hepatitis/cirrhosis/cancer/Fatty liver disease
or also possible cholecystitis or pancreatitis and demands for further
investigations
Spleen Palpation
• not normally palpable, will need to be 2-3 times normal size before palpable.
• To palpate, place left hand behind left 11th and 12th ribs.
• Roll person slightly to their right side and start palpating from LLQ or RUQ
to LUQ, to avoid missing an enlarged spleen.
Clinical significance
• Enlargement of the spleen on palpation may be related to Viral
infections like EBV and mononucleosis, Haemolytic anaemias, or other
blood disorders like leukaemia and lymphoma.
Liver Span
estimated by percussing for the upper and lower borders of liver at the right mid-clavicular line.
Normal adult from 6-12cms
men higher than women of the same
height.
Taller people tend to have longer liver spans than shorter people.
Percussion of the Spleen
• If necessary, the client may roll slightly towards their right side to allow
access to the splenic region.
• will produce a dull note on percussion
between the 9th and 11th intercostal spaces.
• If dullness is found above or below this, or at the anterior axillary line,
then suspect splenomegaly
• Enlargement of the spleen = splenomegaly
• Viral infection – mononucleosis, EBV
• Blood disorders – Leukaemia, sickle cell anaemia
Ascites
the presence of free fluid in the peritoneal cavity.
It can present with building flanks with or without a protuberant abdomen, dullness on percussion and everted umbilicus.
Commonly associated with
- cardiac failure, portal
hypertension, Cirrhosis of liver, hepatitis, pancreatitis, and cancer.
can be differentiated from
gaseous distention by performing the Fluid wave test or the Shifting dullness
test.
Fluid Wave for Ascites
Useful when large quantity of
fluid (2 litres or more) is suspected within
the abdominal cavity.
• Stand on the person’s right side.
Place the ulnar edge of another examiner’s hand or the patient’s own hand firmly on the abdomen in the midline. (This stops transmission across
the skin of the upcoming tap.)
• Place left hand on the person’s right
flank. With right hand, reach across
the abdomen and give the left flank a firm strike
• A positive test will generate fluid wave
through the abdomen, producing a distinct tap on left hand.
Massive ascites may occur from
cirrhosis of liver, heart failure, liver
diseases, ovarian cysts, and rarely in
hydronephrosis
Shifting Dullness for Ascites
Useful for small quantity of fluid (minimum 500ml -1100ml).
It will not be useful in large quantities of fluid as there is little room in the abdominal cavity for the fluid to shift.
• Begin by percussing abdomen in supine position. Percuss across abdomen, note any dullness over flanks.
• Mark point of transmission from tympany to dullness.
• Ask to roll on his or her side (either towards or away from you), wait for 10 seconds to allow any free fluid to settle into the dependent site.
• Begin percussing abdomen from umbilicus to flank area again.
• When present, area of dullness will increase to higher level, as the fluid shifts to the dependent site.
This is a positive test. Small to moderate quantity of fluid in the abdomen, usually from peritonitis, appendicitis, pancreatitis or other local infections and abdominal malignancies
