Midterm Practical: Abdomen exam Flashcards
Abdomen Exam Patient Position & Gown
Supine with hands by side Pillow behind head
Knees bent throughout entire exam
Gown open to the front
Inspecting the Abdomen Steps
1) Ask patient if its okay for you to examine their abdomen
2) State you’re inspecting the surface for Contours and Movements
Areas of Auscultation for Abdomen
4 abdominal Quadrants (DIAPHRAGM)
Hepatic & Splenic Rubs (DIAPHRAGM)
Vascular Abnormal Bruits (BELL)
Auscultation of 4 Abdominal quadrants
Use Diaphragm of Scope
Scope directly on Skin
Listen to 2 areas of each quadrant (NOT over the ribs)
Listen for 3-5 Seconds
Auscultation of Hepatic and Splenic Rubs
Use Diaphragm of Scope
Scope directly on Skin
Listen for 3-5 Seconds (each)
Location of Hepatic Rub Auscultation
Right Costal Margin @ Mid-Clavicular Line
Location of Splenic Rub Auscultation
Left Costal Margin @ Anterior Axillary Line
Auscultation for Abdominal bruits Steps
Use the Bell of the Scope
Scope directly on skin with LIGHT pressure
Stethoscope placed at correct positions
Locations for Auscultating Abdominal Bruits
[5]
Aorta
B/L Renal Arteries
B/L Iliac Arteries
Steps in percussion the Abdomen
1) All 4 quadrants
2) Superior & Inferior Borders of the Liver
3) Percussion for Splenic Dullness
4) Murphy’s Kidney Punch
Percussion of the 4 Abdominal Quadrants Steps
1) 2 Locations in each quadrant
2) Indirect Percussion
3) Elicit Good Tympany Sounds
Percussion of S & I borders of the Liver Steps
1) Shield Breasts
2) First, start @ 2nd/3rd ICS and percussion down until dull (@ Right Mid-Clavicular)
3) Second, Percuss good Tympany and percussion up until dull (@ Right Mid-Clavicular)
Percussion for Splenic Dullness Steps
1) Shield Breasts
2) Location: Left Costal margin & Inferior-most Interspace
3) Go past the anterior Axillary line
4) Elicit good Tympany sounds
5) Repeat steps WHILE PATIENT HOLDS THEIR BREATH
Murphy’s Kidney Punch test Steps
1) Explain to Patient the Procedure
2) Bring patient to seated position
3) Place palm of hand over costovertebral angle
4) Strike back of hand with Ulnar surface (fist) of other hand
5) Ask patient at each strike if any Tenderness
Exam Sequence for the Abdomen Exam
Inspection, Auscultation, Percussion, Palpation
Areas of Palpation for the Abdomen Exam
4 Quadrants
Liver & Gallbladder
Appendix
Right Kidney
Left Kidney
Spleen
Abdominal Aorta
Palpating the 4 Abdominal Quadrants [Superficially]
Use One Hand using pad of the digits
1 Inch Depth
Palpate 2 spots in each quadrant
Move hand in Circular Motion
Palpating the 4 Abdominal Quadrants [DEEPLY]
Use Two Hands (top hand reinforcing bottom hand)
Up to 3 inch Depth OR Patient Tolerance
2 Spots in each quadrant
Use Pads of the digits of inferior hand while pressure is being placed by the superior hand
Use a Circular Motion
4 Abdominal Quadrant Palpation verbals
“Circular Motion” (superficial)
“Circular Motion” (deep)
Ask patient if there is any tenderness
Palpation of the Liver Steps
1) Sheild Breasts
2) Use Hooking Technique
3) Patient Inhales and Holds Breath
4) Palpate while patient is holding inhalation
Hooking technique for palpating the liver
- Stand on RIGHT side of Patient CEPHALAD to costal margin
- Hook Fingers under right costal margin
- Centered at Mid-Clavicular Line
Murphy’s Sign of the Gallbladder Technique
1) Dr. On Pt’s Right side using fingers to press under Right Costal Margin with both hands stacked
2) @ Right Mid-Clavicular
3) Patient instructed to Inhale/Exhale
4) On Exhalation Dr. Presses fingers deeper
5) Patient Inhales one more time
6) Hold Fingers in place during 2nd Inhale
Appendix Palpation: McBurney’s Point Location
2 inches from ASIS on a line between ASIS and Umbilicus
Appendix Palpation: Rovsing Sign
[Rebound Tenderness in the Left Lower Quadrant]
1) Use 2 hands
2) Slowly Press into LLQ
3) Quickly remove hands
