Abdominal Lab

Question 1

Steps

Answer 1

1) Inspection
2) Auscultation
3) Percussion
4) Palpation

Question 2

Cullen sign

Answer 2

ecchymosis around umbilicus secondary to hemorrhage

Question 3

Grey Turner Sign

Answer 3

flank ecchymosis secondary to hemorrhage

Question 4

Normal bowel sounds

Answer 4

5-34 clicks or gurgles per minute

Question 5

abnormal bowel sounds

Answer 5

high pitched

decrease/absent

Question 6

Vascular sounds

Answer 6

• abdominal aorta, iliac, renal and femoral arteries

- listen for bruits with bell

Question 7

Tympany

Answer 7

found in majority of the abdomen, caused by air-filled viscera

Question 8

Dullness

Answer 8

flat sound without echoes, heard over solid organs

• liver and spleen
• fluid in peritoneum or feces gives dull note

Question 9

Percussion of liver

Answer 9

-expected to be 6-12 cm at the mid-clavicular line on the right

Question 10

Percussion of spleen

Answer 10

-expected from ribs 6-10 at the mid-axillary line on the left

Question 11

Light Palpation

Answer 11

use tips of fingers to lightly touch the skin, up to 1cm depth in all four quadrants

Question 12

Moderate Palpation

Answer 12

use fingers or side of hands to lightly touch the skin, 2-3cm depth in all four quadrants

Question 13

Deep Palpation

Answer 13

use fingers and palmar surface of the hand to palpate more than 3cm in all four quadrants

Question 14

Spleen Palpation

Answer 14

• place left hand over and around patient to support and press forward the lower left rib cage
• place right hand below left costal margin, while gently pressing inward, try to feel the tip of the spleen
• normal spleen should NOT be palpable

Question 15

Kidney Palpation

Answer 15

• place cephalad hand behind patient, just below and parallel to 12th rib, presses anteriorly
• place caudad hand just below the costal margin in the RUQ/LUQ respectively, press down firmly and deeply at the peak of patient’s inspiration

Question 16

Aorta Palpation

Answer 16

• palpate just above umbilicus, slightly to left of midline
• estimate the width of the aorta
• expected 2-3 cm in width, pulsation in an anterior-inferior direction
• unexpected >3cm in width, prominent lateral pulsation

Question 17

Visceral Pain

Answer 17

• secondary to distention, stretching or contracting of hollow organs, stretching the capsule of solid organs or organ ischemia
• usually felt in the midline at the level of the structure involved
• not localized

Question 18

Parietal (Somatic) pain

Answer 18

• secondary to inflammation in the parietal peritoneum
• usually constant and more severe than visceral pain
• localized
• aggravated by movement or coughing
• alleviated by remaining still

Question 19

Rebound Tenderness

Answer 19

• pain upon removal of pressure, rather than application of pressure to the abdomen
• indicates peritoneal inflammation

Question 20

Guarding

Answer 20

-voluntary tightening of abdominal muscles secondary to pain

Question 21

Rigidity

Answer 21

-abdomen is hard, involuntary reflex contraction of abdominal wall

Question 22

McBurney’s Point

Answer 22

• rebound tenderness or pain 1/3 of the distance from the ASIS to the umbilicus
• indicated possible appendicitis

Question 23

Rovsings Sign

Answer 23

• pain in the RLQ upon palpation in the LLQ

- indicates possible appendicitis

Question 24

Iliopsoas Muscle Test

Answer 24

• place hand above patients right knee and ask patient to raise thigh against resistance, then turn patient onto their side and extend right leg at the hip
• increased abdominal pain is a + test; indicates irritation of psoas muscle from inflammation of appendix
• low sensitivity

Question 25

Obturator Muscle Test

Answer 25

- flex the patients right thigh at the hip, with the knee bent, and rotate the leg internally at the hip - right hypogastric pain is + test - indicates irritation of the obturator muscle from inflammation of the appendix - low sensitivity

Question 26

Heel Strike

Answer 26

- with patient supine, strike patients heel - positive test is abdominal pain - indicates possible appendicitis or peritonitis

Question 27

Fluid wave for ascites

Answer 27

- ask patient to rest hands over chest - have an assistant place ulnar aspects of hands midline, then tap one flank sharply with finger tips - normal = no impulse felt on the other flank - ascites/positive test = impulse transmitted to the other flank

Question 28

Murphy's Sign

Answer 28

- palpate deeply under right costal margin during inspiration - positive test is pain and/or sudden stop in inspiratory effort - indicates acute cholecytitis

Question 29

Courvoiser's Sign

Answer 29

- enlarged non-tender gallbladder | - indicates pancreatic disease/cancer

Question 30

Lloyd Punch/Kidney | Punch/Costovertebral Angle (CVA)

Answer 30

-tenderness: gently tap area of the back overlying the kidney