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Clinical Examinations > Abdominal Examination > Flashcards

Abdominal Examination Flashcards

1
Q

State the 8 stages of your abdominal examination

A
  1. Introduction
  2. General inspection
  3. Hands & arms
  4. Head & neck
  5. Chest
  6. Abdomen
  7. Legs
  8. Completing the examination
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2
Q

Describe what you must do in the introduction stage of your abdominal examination

A
  • Introduce yourself
  • Check pt name & DOB
  • Explain examination and gain consent
  • Offer chaperone
  • Check if in any pain
  • Wash hands
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3
Q

Describe what you must do in the general inspection stage of your abdominal examination

A

Inspect from end of bed:

Surroundings:

  • NBM, nutritional supplements, NG tube, TPN bags, stoma bags, catheter

Patient:

  • Look well or unwell e.g. look at their colour
  • Conscious level
  • Any obvious pain
  • Nutritional status
  • Abdominal distension
  • Scars
    *
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4
Q

Describe what you must do in the hands & arms stage of your abodominal examination

A
  • Liver flap/asterixis
  • Inspection: clubbing, koilonychia, leuconychia, dupuytren’s contractures, palmar erythema, spider naevi
  • Radial pulse
  • Inspect for arteriovenous haemodialysis fistula (and examine- look, feel, listen- if present)
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5
Q

Describe what you must do in the head & neck stage of your abdominal examination

A
  • Inspect eyes: xanthelasma, conjuctival pallor, corneal acrus, scleral icterus, Kayser-Fleischer ring, yellow sclera
  • Inspect mouth: apthous ulcers, angular stomatitis, gingivitis, buccal pigmentation, glossitis, oral candidiasis, halitosis, fetor hepaticus, dry tongue, dentition
  • Palpate regional lymph nodes (submental, submandibular, pre-auricular, post-auricular, occipital, anterior cervical, posterior cervical)
  • Palpate Virchow’s nodes
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6
Q

Describe what you must do in the chest stage of your abdominal examination

A

Inspect for:

  • Spider naevi
  • Gynaecomastia
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7
Q

The abdomen stage of the abdominal examination is lengthey hence it can be divided into 4 stages; state these stages

A
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
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8
Q

Describe what you must do in the inspection part of the abdomen stage of the abdominal examination

A

Inspect for:

  • Distension
  • Symmetry & shape
  • Pulsations & peristalsis
  • Venous distension
  • Scars
  • Stoma
  • Other e.g. Cullens, Grey Turners
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9
Q

Describe the palpation section of the abdomen stage of your abdominal examination

A
  • Palpate hernia: Ask pt to lift head up or turn head ot side and cough. Comment on warmth & reducibility. Auscultate & comment on bowel sounds.
  • Light palpation (9 areas)
  • Deep palpation (9 areas)
  • Rebound tenderness (if tenderness elicited earlier)
  • Percussion tenderness (if tenderness elicited earlier)
  • Liver palpation
  • Spleen palpation
  • Kidneys palpation
  • Bladder palpation
  • Abdominal aorta palpation
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10
Q

Describe the percussion section of the abdomen stage of the abdominal examination

A

Percuss:

  • Liver
  • Spleen
  • Bladder (from epigastrium down to symphysis pubis)
  • Ascites (shifting dullness or fluid thrill)
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11
Q

Describe the auscultation section of the abdomen stage of the abdominal examination

A

Auscultate:

  • Bowel sounds
  • Aorta
  • Renal arteries
  • Liver bruits
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12
Q

Describe what you must do in the legs stage of your abdominal examination

A

Inspect for:

  • Erythema nodosum
  • Pyoderma gangrenosum
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13
Q

Describe what you must do in the completing the examination part of your abdomen examination

A

Offer to inspect:

  • Hernial orifices
  • External genitalia
  • DRE
  • Bedside: temp, urinalysis
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14
Q

How must you position your patient for an abdominal examination?

*HINT: you may have to change the position of your pt

A
  • For initial general inspection lie them at 45o
  • For abdomen stage lie pt flat with arms by side
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15
Q
A
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16
Q

At what level should you be when palpating the abdomen and why?

A
  • Level of patient
  • To you can look at patient and see if they are in any pain
17
Q

Describe how you test for rebound tenderness

What does rebound tenderness indicate?

A
  • Press deeply/firmly on abdomen then quickly release and observe pt for pain
  • Rebound tenderness (also known as Blumburg’s sign) indicates peritonitis
18
Q

What is McBurney’s sign and what is it indicative of?

A
  • Tenderness at McBurneys point (1/2 way from ASIS to umbilicus)
  • Appendicitis
19
Q

Describe how you palpate the liver

A
  • Ask patient to take some deep breaths
  • Starting in RIF use inner edge of index finger and hand
  • Move towards right costal margin

*NOTE: liver should not be palpable unless enlarged. If it is enlarged you must make note of its size: measure as the number of fingers below the costal margin in mid clavicular line then percuss along mid-clavicular line to confirm. Also comment on nodularity

20
Q

If the liver is palpable on examination and therefore is enlarged, describe how you would measure the size of the enlarged liver

A
  • Measure as the number of fingers below the costal margin in mid clavicular line
  • Then percuss along mid-clavicular line to confirm
  • Also comment on nodularity
21
Q

Describe how you palpate the spleen

A
  • Ask patient to take some deep breaths
  • Start in RIF
  • Using inner edge of index finger & hand, move towards the left costal margin
  • Move hand on expiration

NOTE: spleen should not be palpable unless splenomegaly is present

22
Q

If the spleen is palpable on examination and therefore is enlarged, describe how you would measure the size of the spleen

A
  • Measure as number of fingers below the costal margin in the mid-clavicular line
  • Then percuss along the same line as palpated
23
Q

Describe how you would palpate the kidneys

A
  • Place your left hand on patients back, below ribs and underneath right flank
  • Place your right hand on patients anterior abdomen just under costal margin
  • Push your fingers together, pushing upwards with left hand and downwards with right hand
  • Ask pt to take a deep breath and you may lower pole of kidney between your hands
  • If you feel the kidneys, take note of size and consistency

*NOTE: kidneys not usually palpalbe unless enlarged but right kidney may be palpable if patient has low BMI

24
Q
A
25
Q

Describe how you palpate the abdominal aorta

What is a normal result?

What is an abnormal result?

A
  • First, use both hands to perfom deep palpation just superior to umbilicus in midline (in epigastrium region) to check for pulsatile mass
  • Then, deep palpation either side of midline (again just superior to umbilicus) to assess for expansile mass
  • Normal: hands move superiorly (with each pulsation of aorta)
  • Abnormal: hands move outwards (indicates expansile mass e.g.AAA)
26
Q

Is the bladder palpable in health individuals?

A

No bladder not usually palpable in healthy individuals. If palpable indicated distension

27
Q

Describe how you assess shifting dullness

What does shifting dullness indicate?

A
  • Percuss abodmen from umbilicus laterally until dullness is noted
  • Keep hands in place and ask pt to roll towards/away from you
  • Wait about 30 secs then percuss same area again

*If no longer dull this represents shifting dullness (ascites moving down with gravity)

28
Q

Describe how you assess fluid thrills

A
  • Pt lie supine
  • Get pt/chaperone to place medial edge of palm firmly along midline overlying umbilicus
  • Place your hands on either side and gently flick fingers on one side and see if you can feel the impulse with hands on other side

*If ripple is felt, this represents a fluid thrill and suggests possible ascites)

29
Q

What is a bruit?

A

Whooshing sound due to turbulent blood flow

30
Q

Describe where you would listen for renal bruits

What could renal bruits indicate?

A
  • About 1-2cm above umbilicus, just lateral to midline
  • Renal bruits could indicate renal artery stenosis
31
Q

Describe where you would listen for aortic bruits?

What may an aortic bruit be associated with?

A
  • Ausculate 1-2cm above umbilicus
  • Bruit here may be associated abdominal aortic aneursyem
32
Q

Describe where you would listen for liver bruits

A

Clinical Examinations (16 decks)

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