Phys Dx. Abdominal Practical

Front 1

Abdominal Examination Sequence

Back 1

Positioning, inspection, bowel sounds auscultation, palpation, assessment of: Liver, Spleen, Kidneys, Abdominal Aorta, ascites, appendicitis and cholecystitis, inguinal and femoral hernia

Front 2

positioning and intro

Back 2

Where does it hurt?
pt. supine w/ knees and hips flexed, and hands at sides
dr. stays on right side
instruct pt. to open pants when needed

Front 3

Inspection of abdomen

Back 3

contour, site and shape of umbilicus; skin, dilated veins, visible peristalsis or pulsations, movement of 4 quadrants with respiration

Front 4

auscultation of bowel sounds

Back 4

assessment of intestinal motility; absence is abnormal.
use diaphragm in 4 quadrants
5-35/minute is normal
listen for bruits (caused by turbulent blood flow from atherosclerosis or vascular obstruction)
use bell for abdominal aorta, renal arteries, iliac arteries

Front 5

superficial palpation

Back 5

to detect muscle guarding (peritonitis), find superficial masses, or find ventral wall hernias

Front 6

deep palpation

Back 6

have patient inhale, exhale, then palpate
palpate all 4 quadrants
purpose- assess for organomegaly

Front 7

Liver assessment

Back 7

percuss right MCL to assess for liver size (6-12cm normal)
mark w/ skin marking pencil
palpate while supporting posterior ribs to assess lower liver border or detect hepatomegaly

Front 8

spleen assessment

Back 8

splenic percussion sign test to detect splenomegaly
support posterior ribs and palpate to detect splenomegaly

Front 9

kidney assessment

Back 9

stand on side of kidney you assess
support posterior inferior ribs with superior hand and palpate with inferior hand
to detect enlarged/displaced kidney

Front 10

murphy's punch

Back 10

patient seated
punch gently at each costophrenic angle
to assess hydronephrosis and phelonephritis (infection)

Front 11

abdominal aorta assessment

Back 11

bimanual deep palpation
to detect AAA
normal width is less than 3cm

Front 12

ascites assessment

Back 12

need assistant to block midline
look for fluid wave

Front 13

assessment for appendicitis

Back 13

observe patients gait, cough test, jumping
abdominal superficial palpation for muscle guarding and cutaneous hyperesthesia
iliopsoas sign- thomas test
obturator sign- internal rotation of femur
rovsing's and blumberg's signs

Front 14

assessment for acute cholecystitis

Back 14

hook fingers under right costal margin, patient inhales, pain is murphys sign