Podcast
Questions and Answers
What is the correct order of core examination skills in an abdominal assessment?
What is the correct order of core examination skills in an abdominal assessment?
- Inspection, Palpation, Auscultation, Percussion
- Inspection, Auscultation, Percussion, Palpation (correct)
- Palpation, Percussion, Auscultation, Inspection
- Auscultation, Palpation, Inspection, Percussion
During abdominal inspection, what characteristics should be assessed?
During abdominal inspection, what characteristics should be assessed?
- Tone, Symmetry, Surface motion, Contour
- Skin, Symmetry, Surface motion, Contour (correct)
- Skin, Asymmetry, Deep motion, Tone
- Skin, Symmetry, Deep motion, Tone
During abdominal inspection, when should the abdominal muscles be inspected?
During abdominal inspection, when should the abdominal muscles be inspected?
- While the patient is exhaling slowly.
- While the patient is holding their breath.
- While the patient is lying supine.
- While the patient raises their head. (correct)
What is a Linea Nigra?
What is a Linea Nigra?
Bowel sounds are typically characterized by which of the following?
Bowel sounds are typically characterized by which of the following?
What does the presence of high-pitched tinkling sounds during auscultation of the abdomen suggest?
What does the presence of high-pitched tinkling sounds during auscultation of the abdomen suggest?
After how many minutes of continuous listening without hearing any bowel sounds can they be considered absent?
After how many minutes of continuous listening without hearing any bowel sounds can they be considered absent?
What condition is commonly associated with decreased bowel sounds?
What condition is commonly associated with decreased bowel sounds?
What is the term for loud, prolonged gurgles often associated with stomach growling?
What is the term for loud, prolonged gurgles often associated with stomach growling?
What is a 'bruit' in the context of abdominal auscultation?
What is a 'bruit' in the context of abdominal auscultation?
When auscultating for bruits, which part of the stethoscope is best suited for detecting these sounds?
When auscultating for bruits, which part of the stethoscope is best suited for detecting these sounds?
When ascultating the abdomen, where are bruits typically best heard?
When ascultating the abdomen, where are bruits typically best heard?
What is a venous hum?
What is a venous hum?
A venous hum is associated with increased collateral circulation between which venous systems?
A venous hum is associated with increased collateral circulation between which venous systems?
When percussing the abdomen, what are the key elements to assess?
When percussing the abdomen, what are the key elements to assess?
In which anatomical location is splenic dullness best assessed during percussion?
In which anatomical location is splenic dullness best assessed during percussion?
During light palpation of the abdomen, what is the recommended approach?
During light palpation of the abdomen, what is the recommended approach?
When performing light palpation of the abdomen, approximately how deep should you press?
When performing light palpation of the abdomen, approximately how deep should you press?
In deep palpation of the abdomen, what structures should be deeply palpated for?
In deep palpation of the abdomen, what structures should be deeply palpated for?
What is the primary purpose of the shifting dullness test?
What is the primary purpose of the shifting dullness test?
What is the purpose of the fluid wave test?
What is the purpose of the fluid wave test?
The appearance of Cullen's sign is indicative of what?
The appearance of Cullen's sign is indicative of what?
What is Grey Turner's sign?
What is Grey Turner's sign?
What does the Blumberg sign assess for?
What does the Blumberg sign assess for?
The iliopsoas muscle test is performed by the examiner pushing downwards on the patients leg while the patient is:
The iliopsoas muscle test is performed by the examiner pushing downwards on the patients leg while the patient is:
During the iliopsoas muscle test, what action by the patient would indicate a positive sign?
During the iliopsoas muscle test, what action by the patient would indicate a positive sign?
What maneuver is performed during the Obturator muscle test?
What maneuver is performed during the Obturator muscle test?
A patient presenting with periumbilical bruising should be evaluated for:
A patient presenting with periumbilical bruising should be evaluated for:
Decreased bowel sounds are commonly associated with:
Decreased bowel sounds are commonly associated with:
What is palpated for in the midline during deep palpation of the abdomen?
What is palpated for in the midline during deep palpation of the abdomen?
What is a key difference between light and deep palpation of the abdomen?
What is a key difference between light and deep palpation of the abdomen?
What is the recommended sequence to palpate the abdomen?
What is the recommended sequence to palpate the abdomen?
Which of the following findings during abdominal auscultation would most strongly suggest a surgical emergency?
Which of the following findings during abdominal auscultation would most strongly suggest a surgical emergency?
A patient in their second trimester of pregnancy has a clearly defined, vertical, hyperpigmented line along the midline of their abdomen. How should this finding be interpreted?
A patient in their second trimester of pregnancy has a clearly defined, vertical, hyperpigmented line along the midline of their abdomen. How should this finding be interpreted?
During percussion, a large area of dullness is noted over the spleen in the left midaxillary line. What condition does this most likely indicate?
During percussion, a large area of dullness is noted over the spleen in the left midaxillary line. What condition does this most likely indicate?
Which of the following is the MOST accurate description of the modified Blumberg's sign and what does a positive test generally indicate?
Which of the following is the MOST accurate description of the modified Blumberg's sign and what does a positive test generally indicate?
During an abdominal examination on a 68-year-old male patient, you auscultate a harsh or musical intermittent sound over the right renal artery area. What should this finding prompt you to consider?
During an abdominal examination on a 68-year-old male patient, you auscultate a harsh or musical intermittent sound over the right renal artery area. What should this finding prompt you to consider?
Dullness during percussion over the abdomen is typically caused by any of the following EXCEPT:
Dullness during percussion over the abdomen is typically caused by any of the following EXCEPT:
A 75-year-old patient presents with abdominal pain, distention, and is unable to pass gas. Auscultation reveals high-pitched tinkling sounds. What is the MOST likely cause of these findings?
A 75-year-old patient presents with abdominal pain, distention, and is unable to pass gas. Auscultation reveals high-pitched tinkling sounds. What is the MOST likely cause of these findings?
A patient displays both Cullen's and Grey Turner's signs, what is the most likely underlying cause of these symptoms?
A patient displays both Cullen's and Grey Turner's signs, what is the most likely underlying cause of these symptoms?
Understanding that the liver is located in the right upper quadrant (RUQ), what percussion sound/note would you typically expect hear upon percussing this area in a patient without underlying conditions?
Understanding that the liver is located in the right upper quadrant (RUQ), what percussion sound/note would you typically expect hear upon percussing this area in a patient without underlying conditions?
A clinician is performing an abdominal exam, upon light palpation they noticed extreme involuntary rigidity of the abdominal wall. Which condition should the clinician be highly suspicious for?
A clinician is performing an abdominal exam, upon light palpation they noticed extreme involuntary rigidity of the abdominal wall. Which condition should the clinician be highly suspicious for?
When preparing a patient for an abdominal examination, which of the following actions would MOST effectively promote relaxation of the abdominal wall?
When preparing a patient for an abdominal examination, which of the following actions would MOST effectively promote relaxation of the abdominal wall?
During the inspection of a patient's abdomen, you note a sunken or hollowed appearance. Which term BEST describes this finding?
During the inspection of a patient's abdomen, you note a sunken or hollowed appearance. Which term BEST describes this finding?
During abdominal inspection, which of the following instructions would be MOST appropriate to give a patient to highlight any changes in abdominal contour?
During abdominal inspection, which of the following instructions would be MOST appropriate to give a patient to highlight any changes in abdominal contour?
Which of the following is a NORMAL finding when inspecting the umbilicus?
Which of the following is a NORMAL finding when inspecting the umbilicus?
What condition MOST commonly results in silvery white striae?
What condition MOST commonly results in silvery white striae?
During an abdominal assessment, you observe prominent, dilated veins (caput medusae). This finding is MOST indicative of which condition?
During an abdominal assessment, you observe prominent, dilated veins (caput medusae). This finding is MOST indicative of which condition?
When assessing a patient with suspected dehydration, which assessment finding related to skin turgor would you MOST likely observe?
When assessing a patient with suspected dehydration, which assessment finding related to skin turgor would you MOST likely observe?
You observe pulsations in the epigastric area of a thin patient with good muscle wall relaxation. What is the MOST likely cause of this finding?
You observe pulsations in the epigastric area of a thin patient with good muscle wall relaxation. What is the MOST likely cause of this finding?
Which demeanor is MOST commonly associated with a patient experiencing the colicky pain of gastroenteritis or bowel obstruction?
Which demeanor is MOST commonly associated with a patient experiencing the colicky pain of gastroenteritis or bowel obstruction?
Why is auscultation performed before percussion and palpation in an abdominal examination?
Why is auscultation performed before percussion and palpation in an abdominal examination?
Which part of the stethoscope is BEST used to auscultate bowel sounds?
Which part of the stethoscope is BEST used to auscultate bowel sounds?
Where is the BEST location to begin auscultating for bowel sounds?
Where is the BEST location to begin auscultating for bowel sounds?
What is borborygmus?
What is borborygmus?
Which statement BEST describes how hyperactive bowel sounds should be documented?
Which statement BEST describes how hyperactive bowel sounds should be documented?
A patient is suspected of having a "silent abdomen". How long should the clinician listen in each quadrant to confirm the absence of bowel sounds?
A patient is suspected of having a "silent abdomen". How long should the clinician listen in each quadrant to confirm the absence of bowel sounds?
When checking for vascular sounds during an abdominal examination, what instructions should be given to the patient?
When checking for vascular sounds during an abdominal examination, what instructions should be given to the patient?
Which arteries should be auscultated when checking vascular sounds in the abdomen?
Which arteries should be auscultated when checking vascular sounds in the abdomen?
Upon auscultation of the abdomen, you detect a pulsatile blowing sound over the right renal artery. This finding is MOST consistent with?
Upon auscultation of the abdomen, you detect a pulsatile blowing sound over the right renal artery. This finding is MOST consistent with?
Why is it unsafe to use auscultation to confirm placement of nasogastric tubes?
Why is it unsafe to use auscultation to confirm placement of nasogastric tubes?
When percussing the abdomen, what sound should predominate?
When percussing the abdomen, what sound should predominate?
What is the MOST likely cause of dullness to percussion in the abdomen?
What is the MOST likely cause of dullness to percussion in the abdomen?
When is percussion of the liver span omitted during an abdominal assessment?
When is percussion of the liver span omitted during an abdominal assessment?
Why should detection of a distended bladder through percussion be omitted from the Abdominal Assessment?
Why should detection of a distended bladder through percussion be omitted from the Abdominal Assessment?
If CVA tenderness is assessed during the abdominal assessment, what organ are you assessing?
If CVA tenderness is assessed during the abdominal assessment, what organ are you assessing?
During light palpation, what depth should the nurse depress the skin?
During light palpation, what depth should the nurse depress the skin?
When performing light palpation of the abdomen, what is the main objective?
When performing light palpation of the abdomen, what is the main objective?
When palpating the abdomen, what is the MOST appropriate action to take to minimize voluntary guarding?
When palpating the abdomen, what is the MOST appropriate action to take to minimize voluntary guarding?
Involuntary rigidity is noted during palpation of the abdomen. What is the MOST likely cause?
Involuntary rigidity is noted during palpation of the abdomen. What is the MOST likely cause?
The bimanual technique is used to palpate what type of abdomen?
The bimanual technique is used to palpate what type of abdomen?
A clinician uses two hands on top of one another for deep palpation. What does the bottom hand concentrate on?
A clinician uses two hands on top of one another for deep palpation. What does the bottom hand concentrate on?
The sigmoid colon is found in which abdominal quadrant?
The sigmoid colon is found in which abdominal quadrant?
When palpating the abdomen, which finding requires further investigation?
When palpating the abdomen, which finding requires further investigation?
What can an abnormally firm liver indicate?
What can an abnormally firm liver indicate?
If the spleen is enlarged, what should you NOT do?
If the spleen is enlarged, what should you NOT do?
What is expected when palpating the kidneys?
What is expected when palpating the kidneys?
How wide would the aorta be in an adult with normal findings?
How wide would the aorta be in an adult with normal findings?
What does a fluid wave indicate?
What does a fluid wave indicate?
During the fluid wave test, why is it important to have the patient or another examiner place their hand firmly on the abdomen in the midline?
During the fluid wave test, why is it important to have the patient or another examiner place their hand firmly on the abdomen in the midline?
What is the MOST reliable sign of peritoneal inflammation?
What is the MOST reliable sign of peritoneal inflammation?
You are examining a patient for appendicitis. During palpation, you apply pressure in the left lower quadrant and the patient experiences pain in the right lower quadrant. Which sign is this MOST indicative of?
You are examining a patient for appendicitis. During palpation, you apply pressure in the left lower quadrant and the patient experiences pain in the right lower quadrant. Which sign is this MOST indicative of?
During palpation of the abdomen, a patient reports pain and abruptly stops inspiring mid-breath. This is indicative of which sign?
During palpation of the abdomen, a patient reports pain and abruptly stops inspiring mid-breath. This is indicative of which sign?
What is the correct anatomical of McBurney's point?
What is the correct anatomical of McBurney's point?
A patient presents with suspected appendicitis. The iliopsoas muscle test is performed, and the patient reports pain in the RLQ. What does this indicate?
A patient presents with suspected appendicitis. The iliopsoas muscle test is performed, and the patient reports pain in the RLQ. What does this indicate?
During the obturator test, what maneuver is performed by the examiner to elicit pain in a patient with a suspected appendicitis?
During the obturator test, what maneuver is performed by the examiner to elicit pain in a patient with a suspected appendicitis?
What is the MINIMUM Alvarado score in which the probability of appendicitis increases?
What is the MINIMUM Alvarado score in which the probability of appendicitis increases?
Which of the following is NOT a typical finding in a patient with obesity-related abdominal distention?
Which of the following is NOT a typical finding in a patient with obesity-related abdominal distention?
During percussion of the abdomen in a patient with ascites, which of the following findings is MOST likely?
During percussion of the abdomen in a patient with ascites, which of the following findings is MOST likely?
A patient presents with a distended abdomen. Auscultation reveals decreased or absent bowel sounds. Percussion reveals tympany over a large area. Which of the following is the MOST likely cause?
A patient presents with a distended abdomen. Auscultation reveals decreased or absent bowel sounds. Percussion reveals tympany over a large area. Which of the following is the MOST likely cause?
During an abdominal exam, the nurse notes a fluid wave and shifting dullness. What condition would these findings MOST likely indicate?
During an abdominal exam, the nurse notes a fluid wave and shifting dullness. What condition would these findings MOST likely indicate?
In which of the following conditions is an everted umbilicus MOST commonly observed?
In which of the following conditions is an everted umbilicus MOST commonly observed?
In late intestinal obstruction, bowel sounds are typically:
In late intestinal obstruction, bowel sounds are typically:
Which of the following physical examination findings is MOST indicative of peritonitis?
Which of the following physical examination findings is MOST indicative of peritonitis?
Where does pain from cholecystitis MOST commonly radiate?
Where does pain from cholecystitis MOST commonly radiate?
What is the MOST likely cause of acute, boring midepigastric pain radiating to the back, accompanied by severe nausea and vomiting?
What is the MOST likely cause of acute, boring midepigastric pain radiating to the back, accompanied by severe nausea and vomiting?
Which condition typically presents with dull, aching, gnawing epigastric pain that may be relieved by food?
Which condition typically presents with dull, aching, gnawing epigastric pain that may be relieved by food?
A patient reports burning pain in the midepigastric region that radiates upward; this pain occurs 30 to 60 minutes after eating and is aggravated by lying down. What condition is MOST likely?
A patient reports burning pain in the midepigastric region that radiates upward; this pain occurs 30 to 60 minutes after eating and is aggravated by lying down. What condition is MOST likely?
Which of the following is a typical characteristic of pain associated with appendicitis?
Which of the following is a typical characteristic of pain associated with appendicitis?
What type of pain is MOST commonly associated with gastroenteritis?
What type of pain is MOST commonly associated with gastroenteritis?
A patient reports moderate, colicky pain of gradual onset in the lower abdomen and bloating. This is MOST indicative of:
A patient reports moderate, colicky pain of gradual onset in the lower abdomen and bloating. This is MOST indicative of:
Which of the following is TRUE regarding pain associated with irritable bowel syndrome (IBS)?
Which of the following is TRUE regarding pain associated with irritable bowel syndrome (IBS)?
Tenderness to palpation, restlessness, and a distended abdomen are MOST likely physical examination findings of:
Tenderness to palpation, restlessness, and a distended abdomen are MOST likely physical examination findings of:
Upon inspection of a patient's abdomen, you notice a bulge near an old operative scar that appears when the patient stands. What is this MOST consistent with?
Upon inspection of a patient's abdomen, you notice a bulge near an old operative scar that appears when the patient stands. What is this MOST consistent with?
What causes the soft, skin-covered mass associated with an umbilical hernia?
What causes the soft, skin-covered mass associated with an umbilical hernia?
A patient presents with a midline longitudinal ridge in their abdomen. This ridge is revealed when they raise their head while supine. Which condition is MOST likely?
A patient presents with a midline longitudinal ridge in their abdomen. This ridge is revealed when they raise their head while supine. Which condition is MOST likely?
A small, fatty nodule palpable at the epigastrium in the midline is the MOST common characteristic of what?
A small, fatty nodule palpable at the epigastrium in the midline is the MOST common characteristic of what?
A very loud splash auscultated over the upper abdomen when an infant is rocked side to side MOST likely indicates:
A very loud splash auscultated over the upper abdomen when an infant is rocked side to side MOST likely indicates:
In a newborn, marked peristalsis together with projectile vomiting suggests what condition?
In a newborn, marked peristalsis together with projectile vomiting suggests what condition?
Diminished or absent bowel sounds are associated with which condition?
Diminished or absent bowel sounds are associated with which condition?
Which of the following conditions is MOST likely to cause audible, loud, gurgling bowel sounds?
Which of the following conditions is MOST likely to cause audible, loud, gurgling bowel sounds?
When auscultating the abdomen, a rough, grating sound, like two pieces of leather rubbed together, indicates:
When auscultating the abdomen, a rough, grating sound, like two pieces of leather rubbed together, indicates:
Murmurs auscultated during abdominal examination may indicate which condition?
Murmurs auscultated during abdominal examination may indicate which condition?
Aortic aneurysms are MOST commonly located:
Aortic aneurysms are MOST commonly located:
During palpation of the abdomen, an enlarged liver with a smooth, nontender surface is LEAST likely associated with:
During palpation of the abdomen, an enlarged liver with a smooth, nontender surface is LEAST likely associated with:
An enlarged, tender gallbladder is MOST suggestive of which condition?
An enlarged, tender gallbladder is MOST suggestive of which condition?
During palpation, a clinician notices a mass with a splenic notch along the medial edge. What organ is MOST likely enlarged?
During palpation, a clinician notices a mass with a splenic notch along the medial edge. What organ is MOST likely enlarged?
Upon abdominal palpation, how can an enlarged kidney be differentiated from an enlarged spleen?
Upon abdominal palpation, how can an enlarged kidney be differentiated from an enlarged spleen?
Which condition is LEAST likely to be associated with an enlarged and nodular liver?
Which condition is LEAST likely to be associated with an enlarged and nodular liver?
Aortic aneurysms most often present as a
Aortic aneurysms most often present as a
A patient presents with a history of previous abdominal surgery, vomiting, fever, and colicky abdominal pain. Which condition is MOST likely?
A patient presents with a history of previous abdominal surgery, vomiting, fever, and colicky abdominal pain. Which condition is MOST likely?
Which historical finding is MOST closely associated with intestinal obstruction?
Which historical finding is MOST closely associated with intestinal obstruction?
Aortic aneurysms are frequently accompanied by:
Aortic aneurysms are frequently accompanied by:
Which characteristic differentiates the pain of duodenal ulcers from gastric ulcers?
Which characteristic differentiates the pain of duodenal ulcers from gastric ulcers?
After feeding, a pronounced peristaltic wave cross from left to right, leading to projectile vomiting. Clinically, what is an appropriate action?
After feeding, a pronounced peristaltic wave cross from left to right, leading to projectile vomiting. Clinically, what is an appropriate action?
While assessing a patient, the clinician identifies increased intra-abdominal pressure due to ascites. The taut skin and increased intra-abdominal pressure limit palpation, and bowel sounds are diminished over ascitic fluid. Which percussion characteristics should the clinician expect?
While assessing a patient, the clinician identifies increased intra-abdominal pressure due to ascites. The taut skin and increased intra-abdominal pressure limit palpation, and bowel sounds are diminished over ascitic fluid. Which percussion characteristics should the clinician expect?
A clinician identifies a localized distention of the abdomen upon inspection. Which diagnosis would you expect?
A clinician identifies a localized distention of the abdomen upon inspection. Which diagnosis would you expect?
While auscultating a patient's abdomen, the physician detects arterial bruit. Knowing this sound indicates turbulent blood flow, which actions should the physician do NEXT?
While auscultating a patient's abdomen, the physician detects arterial bruit. Knowing this sound indicates turbulent blood flow, which actions should the physician do NEXT?
Flashcards
Abdominal Assessment Techniques
Abdominal Assessment Techniques
The four core examination skills, performed in a specific order: Inspection, Auscultation, Percussion, Palpation.
Abdominal Inspection
Abdominal Inspection
Visual examination of the abdomen, assessing skin characteristics, symmetry, surface motion, and contour.
Abdominal Auscultation
Abdominal Auscultation
Listening for bowel sounds, typically clicks and gurgles, which should occur at a rate of 5 to 35 per minute.
Abdominal Bruits
Abdominal Bruits
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Venous Hum
Venous Hum
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Abdominal Percussion
Abdominal Percussion
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Light Palpation
Light Palpation
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Deep Palpation
Deep Palpation
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Deep Palpation Targets
Deep Palpation Targets
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Shifting Dullness
Shifting Dullness
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Fluid Wave Test
Fluid Wave Test
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Blumberg Sign
Blumberg Sign
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Iliopsoas Muscle Test
Iliopsoas Muscle Test
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Obturator Muscle Test
Obturator Muscle Test
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Abdominal Exam Lighting
Abdominal Exam Lighting
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Enhancing Abdominal Wall Relaxation
Enhancing Abdominal Wall Relaxation
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Inspecting Abdominal Contour
Inspecting Abdominal Contour
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Normal Abdominal Contour
Normal Abdominal Contour
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Scaphoid Abdomen
Scaphoid Abdomen
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Protuberant Abdomen
Protuberant Abdomen
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Normal Abdominal Symmetry
Normal Abdominal Symmetry
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Normal Umbilicus
Normal Umbilicus
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Striae (lineae albicantes)
Striae (lineae albicantes)
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Prominent, Dilated Veins
Prominent, Dilated Veins
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Poor Skin Turgor
Poor Skin Turgor
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Normal Abdominal Demeanor
Normal Abdominal Demeanor
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Hyperactive Bowel Sounds
Hyperactive Bowel Sounds
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Assessing Vascular Sounds
Assessing Vascular Sounds
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Systolic Bruit
Systolic Bruit
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General Abdominal Percussion
General Abdominal Percussion
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Abdominal Dullness
Abdominal Dullness
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Limitations of Percussion
Limitations of Percussion
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Normal Costovertebral Angle Tenderness
Normal Costovertebral Angle Tenderness
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Purpose of Abdominal Palpation
Purpose of Abdominal Palpation
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Voluntary Guarding
Voluntary Guarding
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Involuntary Rigidity
Involuntary Rigidity
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Enlarged Liver Palpation Findings
Enlarged Liver Palpation Findings
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Normal Spleen Palpation
Normal Spleen Palpation
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Normal Kidney Palpation
Normal Kidney Palpation
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Normal Aorta Palpation
Normal Aorta Palpation
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Ascites Distribution
Ascites Distribution
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Normal Inspiratory Arrest (Murphy Sign)
Normal Inspiratory Arrest (Murphy Sign)
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McBurney Point
McBurney Point
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Alvarado Score Components
Alvarado Score Components
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Obesity (Abdominal)
Obesity (Abdominal)
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Abdominal Air/Gas
Abdominal Air/Gas
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Abdominal Ascites
Abdominal Ascites
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Large Ovarian Cyst
Large Ovarian Cyst
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Abdominal Feces
Abdominal Feces
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Abdominal Tumor
Abdominal Tumor
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Umbilical Hernia
Umbilical Hernia
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Epigastric Hernia
Epigastric Hernia
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Incisional Hernia
Incisional Hernia
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Diastasis Recti
Diastasis Recti
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Succussion Splash
Succussion Splash
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Peritoneal Friction Rub
Peritoneal Friction Rub
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Arterial Bruit
Arterial Bruit
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Enlarged Liver
Enlarged Liver
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Enlarged Nodular Liver
Enlarged Nodular Liver
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Enlarged Kidney
Enlarged Kidney
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Study Notes
- Abdominal assessment involves core examination skills in a specific sequence.
Sequence of Examination Skills:
- Inspection comes first.
- Ascultation is second.
- Percussion is third.
- Palpation is fourth.
Abdomen - Inspection
- Assess skin characteristics, symmetry, surface motion, and contour.
- Inspect abdominal muscles as the patient raises their head to check for masses, hernias, or separation of muscles.
- Possible contours include flat, scaphoid, rounded, and protuberant.
Auscultation - Bowel Sounds
- Assess bowel sounds for frequency and character.
- Normal bowel sounds are clicks and gurgles, irregularly occurring at a rate of 5 to 35 per minute.
- Sounds can be assessed adequately by listening in one place due to their generalized nature.
- Loud, prolonged gurgles are known as borborygmi, or stomach growling.
- Increased bowel sounds may indicate gastroenteritis, early intestinal obstruction or hunger
- High-pitched tinkling sounds suggest intestinal fluid and air under pressure; can indicate early obstruction.
- Absent bowel sounds, which is the inability to hear any sounds after 5 minutes of continuous listening, are typically associated with abdominal pain and rigidity and are a surgical emergency.
- Decreased bowel sounds could suggest peritonitis or paralytic ileus.
Auscultation - Bruits
- Bruits are harsh or musical intermittent auscultatory sounds that may reflect blood flow turbulence and indicate vascular disease.
- Bruits are heard best with the bell of the stethoscope.
- Listen for bruits in the epigastric region and over the aortic, renal, iliac, and femoral arteries.
Auscultation - Venous Hum
- Venous hums are soft, low-pitched, and continuous sounds heard best with the bell of the stethoscope.
- These sounds occur with increased collateral circulation between portal and systemic venous systems.
- Venous hums can be found in the epigastric region and around the umbilicus.
Percussion
- Percuss the abdomen to assess tone in all four quadrants, liver borders, splenic dullness in the left midaxillary line, and the gastric air bubble.
Palpation - Light Palpation
- Light systematic palpation is done in all four quadrants to examine the abdomen.
- Avoid areas that have already been identified as problem spots.
- The figure illustrates palpation of the abdomen with fingers extended and approximated, pressing in no more than 1 cm.
Palpation - Deep Palpation
- Deep palpation is done to assess bulges and masses around the umbilicus and umbilical ring, liver border in the right costal margin, spleen in the left costal margin, right and left kidneys, and aortic pulsation in midline.
- Press deeply and evenly with the palmar surface of extended fingers.
- One method for liver palpation has fingers extended, with tips on the right midclavicular line below the level of liver dullness and pointing toward the head.
- An alternative method for liver palpation involves positioning the fingers parallel to the costal margin.
- Finally, the liver can be palpated with the fingers hooked over the costal margin.
Palpation - Spleen and Kidney
- Palpate for the spleen with the right hand below the left costal margin.
- When palpating the spleen with the patient lying on their side, press inward with the left hand and tips of the right fingers.
- Palpate the left kidney by elevating the left flank with the left hand and palpating deeply with the right hand.
- Use the capture technique for palpating the kidney by pressing the fingers of both hands together as the patient takes a deep breath. When the patient exhales, slowly release the pressure and feel for the kidney to slip between the fingers
Palpation - Aorta
- Palpate the aorta by placing the thumb on one side of the aorta and the fingers on the other side.
Fluid Assessment - Ascites
- Fluid assessment to test for ascites involves testing for shifting dullness and fluid wave.
Abdominal Signs
- Specific abdominal signs to look for include Blumberg, Iliopsoas, McBurney Point, Obturator, Cullen, and Grey Turner.
- Testing for Rebound Tenderness involves pressing deeply and gently into the abdomen and then rapidly withdrawing the hands and fingers.
- The Iliopsoas Muscle Test involves the patient raising the leg from the hip while the examiner pushes downward against it, or alternately the examiner hyperextending the right leg by drawing it backward while the patient lies on the left side.
- The Obturator Muscle Test involves flexing the right leg at the hip and knee and then rotating the leg laterally and medially.
Abnormal Findings - Abdominal Distention
- Abdominal distention can be caused by obesity, air or gas, ascites, large ovarian cysts, pregnancy, feces, or tumors.
Abdominal Distention - Obesity
- Inspection: The abdomen is uniformly rounded with a sunken umbilicus (adheres to the peritoneum, layers of fat superficial to it).
- Auscultation: Normal bowel sounds.
- Percussion: Tympany with scattered dullness over adipose tissue.
- Palpation: Normal, but may be hard to feel through thick abdominal wall.
Abdominal Distention - Air or Gas
- Inspection: Single round curve.
- Auscultation: Depends on the cause of the gas (decreased or absent bowel sounds with ileus; hyperactive with early intestinal obstruction).
- Percussion: Tympany over a large area.
- Palpation: May have muscle spasm of the abdominal wall.
Abdominal Distention - Ascites
- Inspection: Single curve, everted umbilicus, bulging flanks when supine, taut, glistening skin (recent weight gain), increased abdominal girth.
- Auscultation: Normal bowel sounds over the intestines, diminished over ascitic fluid.
- Percussion: Tympany at the top where intestines float, dull over fluid. Produces fluid wave and shifting dullness.
- Palpation: Taut skin, increased intra-abdominal pressure limits palpation.
Abdominal Distention - Large Ovarian Cyst
- Inspection: Curve in the lower half of the abdomen towards the midline, everted umbilicus.
- Auscultation: Normal bowel sounds over upper abdomen where intestines are pushed superiorly.
- Percussion: Top dull over fluid, intestines pushed superiorly; large cyst produces fluid wave and shifting dullness
- Palpation: Transmits aortic pulsation, whereas ascites does not.
Abdominal Distention - Pregnancy
- Inspection: Single curve, umbilicus protruding, breasts engorged.
- Auscultation: Fetal heart tones, bowel sounds diminished.
- Percussion: Tympany over intestines, dull over enlarging uterus.
- Palpation: Uterine fundus, fetal parts, fetal movements.
Abdominal Distention - Feces
- Inspection: Localized distention.
- Auscultation: Normal bowel sounds.
- Percussion: Tympany predominates, scattered dullness over fecal mass.
- Palpation: Plastic-like or ropelike mass with feces in intestines.
Abdominal Distention - Tumor
- Inspection: Localized distention.
- Auscultation: Normal bowel sounds.
- Percussion: Dull over mass if reaches the skin surface.
- Palpation: Define borders; distinguish from enlarged organ or normally palpable structure.
Intestinal Obstruction - Assessment
- Patient history: Previous abdominal surgery with adhesions, vomiting, fever, absence of stool or gas passage, colicky pain from strong peristalsis above the obstruction.
- Physical exam: Restless/ill appearance, distended abdomen, hyperactive bowel sounds (early), hypoactive/silent bowel sounds (late), tenderness to palpation, hypovolemic shock.
- Diagnostics: Lab evidence (dehydration/electrolyte loss/sepsis), radiology evidence (fluid/gas accumulation proximal to the obstruction).
Referred Abdominal Pain
- Abdominal pain location may not directly reflect the involved organ due to the brain's "felt image" referring pain to a fetal development location.
Referred Abdominal Pain - Liver
- Hepatitis: Mild-to-moderate dull pain in the right upper quadrant (RUQ) or epigastrium plus anorexia, nausea, malaise, low-grade fever.
Referred Abdominal Pain - Esophagus
- GERD: Burning pain in the midepigastrium or behind the lower sternum that radiates upward, occurring 30-60 minutes after eating and worsens when lying down.
Referred Abdominal Pain - Gallbladder
- Cholecystitis: Sudden pain in RUQ that may radiate to the right or left scapula, builds over time after ingesting fatty foods/alcohol/caffeine; associated with nausea/vomiting and positive Murphy's sign.
Referred Abdominal Pain - Pancreas
- Pancreatitis: Acute, boring midepigastric pain radiating to back (sometimes left scapula/flank), severe nausea/vomiting; may worsen with eating, drinking, or supine position.
Referred Abdominal Pain - Duodenum
- Duodenal Ulcer: Dull, aching, gnawing pain that doesn't radiate; may be relieved by food and may awaken the person from sleeping.
Referred Abdominal Pain - Stomach
- Gastric Ulcer: Dull, aching, gnawing epigastric pain brought on by food that radiates to the back/substernal area.
- Perforated Ulcer: Burning epigastric pain with sudden onset referring to one or both shoulders.
Referred Abdominal Pain - Appendix
- Appendicitis: Starts as dull, diffuse periumbilical pain shifting to severe sharp RLQ pain (McBurney point), worsened by movement, associated with anorexia, nausea/vomiting, fever.
Referred Abdominal Pain - Kidney
- Kidney Stones: Sudden onset of severe, colicky, flank or lower abdominal pain.
Referred Abdominal Pain - Small Intestine
- Gastroenteritis: Diffuse, generalized abdominal pain with nausea and diarrhea.
Referred Abdominal Pain - Colon
- Large Bowel Obstruction: Moderate, colicky pain in the lower abdomen and bloating with a gradual onset.
- Irritable Bowel Syndrome (IBS): Sharp or burning cramping pain over a wide area, does not radiate. Brought on by meals, relieved by bowel movement.
Abnormalities on Inspection - Umbilical Hernia
- Soft, skin-covered mass, protrusion of omentum or intestine through weakness/incomplete closure in the umbilical ring.
- Accentuated by increased intra-abdominal pressure, rarely incarcerates/strangulates.
- More common in premature infants, resolves spontaneously by 1 year.
- In adults, occurs with pregnancy, chronic ascites, or increased intrathoracic pressure.
Abnormalities on Inspection - Epigastric Hernia
- Protrusion of abdominal structures, small fatty nodule at epigastrium in midline through the linea alba.
- Palpable when standing.
Abnormalities on Inspection - Incisional Hernia
- Bulge near an old operative scar, apparent when person increases intra-abdominal pressure.
Abnormalities on Inspection - Diastasis Recti
- Midline longitudinal ridge, separation of abdominal rectus muscles; occurs with increased intra-abdominal pressure (raising head while supine).
- Can occur congenitally/pregnancy/obesity; Usually not clinically significant.
Abnormal Bowel Sounds - Succussion Splash
- Unrelated to peristalsis, very loud splash auscultated over the upper abdomen when the infant is rocked side to side
- Indicates increased air and fluid in the stomach (pyloric obstruction/large hiatal hernia).
Abnormal Bowel Sounds - Marked Peristalsis
- Occurs together with projectile vomiting in newborns and suggests pyloric stenosis. Palpate for olive-size mass in RUQ.
Abnormal Bowel Sounds - Hypoactive
- Diminished/absent bowel sounds signal decreased motility from inflammation (peritonitis), paralytic ileus, late bowel obstruction, or pneumonia.
Abnormal Bowel Sounds - Hyperactive
- Loud, gurgling sounds (“borborygmi”) signal increased motility.
- Occur with early mechanical bowel obstruction (high-pitched), gastroenteritis, brisk diarrhea, laxative use, and subsiding paralytic ileus.
Abnormal Vascular Sounds - Peritoneal Friction Rub
- Rough grating sound like two pieces of leather rubbed together; indicates peritoneal inflammation over organs with large surface area contacting peritoneum.
- Liver friction rub occurs over the lower right rib cage from abscess or metastatic tumor.
- Spleen friction rub occurs over the lower left rib cage from abscess or infection.
Abnormal Vascular Sounds - Arterial Bruit
- Indicates turbulent blood flow (constricted/abnormally dilated/tortuous vessels).
- Aortic aneurysm murmur is harsh or continuous/accentuated with systole.
- Renal artery stenosis murmur is midline/toward flank; soft, low-to-medium pitch.
- Partial occlusion of femoral arteries.
Abnormal Vascular Sounds - Venous Hum
- Heard in periumbilical region stemming from inferior vena cava.
- Medium pitch, continuous sound; pressure on bell may obliterate it.
- May have palpable thrill; occurs with portal hypertension/cirrhotic liver.
Palpation - Enlarged Liver
- Smooth, nontender liver: Fatty infiltration, portal obstruction, cirrhosis, high obstruction of inferior vena cava/lymphocytic leukemia.
- Enlarged, smooth, tender liver: Early heart failure, acute hepatitis, or hepatic abscess.
- Enlarged, nodular liver: Late portal cirrhosis, metastatic cancer, or tertiary syphilis.
Palpation - Enlarged Gallbladder
- Enlarged, tender gallbladder: Acute cholecystitis; exquisitely painful to fist percussion/inspiratory arrest (Murphy's sign).
- Enlarged, nontender gallbladder: filled with stones with common bile duct obstruction.
Palpation - Enlarged Spleen
- Enlarges down/toward midline until stopped by the diaphragm.
- Acute infections (mononucleosis): Moderately enlarged/soft, rounded edges.
- Chronic cause: Firm/hard, sharp edges, usually not tender unless peritoneum is inflamed.
Palpation - Enlarged Kidney
- Enlarged with hydronephrosis/cyst/neoplasm; extends forward/down, has no palpable notch; kidney is tympanitic due to overriding bowel.
Palpation - Aortic Aneurysm
- Most aortic aneurysms are located below the renal arteries and extend to the umbilicus.
- Focal bulging > 5cm palpable in 80% of cases like pulsating mass in the upper abdomen left of midline, hear bruit, femoral pulses present but diminished.
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