midterm: abdominal exam Flashcards
What kinds of findings are we looking for on inspection of the abdomen?
Skin markings: Scars, striae, dilated vessels.
Contour: Flatness. Distension, noting any of the “7 Fs”. Concavity. Symmetry.
Peristalsis: Increased with obstruction.
Pulsations: From vessels, abdominal aortic aneurysm (triple A).
Hernias: Most are umbilical.
Ecchymosis: Infiltration of the extraperitoneal tissues with blood.
What are the 7 F’s for a distended abdomen?
the “7 Fs”:
fat, fluid, fetus, feces, flatus, fibroid, fatal growth.
Why do we auscultate the abdomen before palpation?
So that we don’t falsely increase bowel sounds.
Understand normal and abnormal bowel sounds.
High-pitched tinkling sounds: Early obstruction.
Absent sounds: Late mechanical obstruction or ileus (adynamic bowel).
Secussion splash: Air and fluid, obstruction, pyloric stenosis.
Peritoneal friction rub: Inflammation.
Borborygmus (long prolonged gurgles): Gastroenteritis.
Bruits over aorta and renal, iliac, and femoral arteries: Obstruction.
Be able to perform abdominal percussion using exemplary technique.
Percuss all quadrants, listening for patterns of dullness and tympany. Unusual dullness may indicate an underlying abdominal mass. Percuss outline of liver, spleen, and stomach
What is the expected liver span at the midclavicular line?
should be 6-12 cm in a normal adult
What is the splenic percussion sign? Know how to perform it.
Percuss the lowest costal interspace in the left anterior axillary line. This area is normally tympanic.
Ask the patient to take a deep breath and percuss this area again. Dullness in this area is a sign of splenic enlargement.
Why and how do we do light palpation? What can you do about ticklish patients?
Ticklish: use their own hand
Light: Note any guarding or tenderness, hyperesthesia, rigidity.Relax pt
Deep: note masses, guaridng. Palpate liver, spleen, kidneys
Measure the width of the aorta; the normal size is ~3 cm. A large pulsatile mass is suggestive of aortic aneurism.
What is the significance of guarding and rigidity?
Pain, peritoneal inflammation. Acute process
Which arteries are important to auscultate for bruits over the abdomen?
Aortic, renal, illiac
What is Murphy’s Sign?
Gallbladder tenderness on inspiration when it is being palpated.
What is rebound tenderness at McBurney’s Point? Referred rebound tenderness (Rovsing)?
Mcburney’s point : Between right illiac crest and umbilicus. Deep palpation and sudden release elicits pain= positive for appendicitis.
Rovsings= same as mcburneys but on the left side.
Be able to demonstrate psoas sign, obturator sign, costovertebral angle (CVA) tenderness.
Psoas: have pt try to flex hip=pain? appendicitis
Obturator: passively internally rotate hip=pain? appendicitis
CVA tenderness with kidney palpation and percussion?=pyloneprhitis
