General Inspection
Pt is supine
- inspect skin for scars, lesions, tattoos
- inspect for size, contour, symmetry of abdomen
- observe for visible peristalsis and aortic pulsations
- have patient lift head then observe for masses, hernias, or separation of muscles
Auscultation
Use diaphragm, listen to all 4 quadrants. Normal bowel sounds around between 5-34 sounds per minute. Must listen for 5 minutes to declare absence of sounds
Palpation
Ask pt if they are tender anywhere, start farthest away from that area.
- lightly palpate with one hand all 4 quadrants
- use two hands for deep palpation, describe any masses felt
- palpate liver: place left hand behind pt supporting 11-12 ribs, place right hand in RUQ, have pt take a deep breath and try to trace edge of liver
Auscultation for bruits
Use bell. Check aortic (slightly to left of midline), renal (on both sides of aorta in epigastric area), and iliac (on both sides of aorta just below umbilicus
Percussion
Percuss all 4 quadrants. Should hear tympany but dullness can be expected due to stool and liver.
- liver: start RLQ, percuss up midclavicular line until dullness is heard. Then start at R side of chest below breast ad percuss down to dullness. Space between should be 6-12 cm
Additional Palpation
- Murphy’s Sign: palpate below liver margin on RUQ and ask patient to take a deep breath. Pain is positive.
- McBurney’s Point: Press firmly with fingers at 90 angle in RLQ, release quickly. Pain with rebound is positive.
- Spleen: With Left hand reach around and support right cage forward, with R hand press below left costal margin. Have patient take a deep breath. Repeat with patient lying on R side with legs and hips slightly flexed.
- Aorta: press firmly and deeply into upper abdomen, slightly to L of midline. Feel for pulsations. Try to measure width.
Rebound tenderness
press firmly with fingers at 90 into abdomen and release quickly. Pain with release is positive. If LLQ is positive, could be referred rebound.
CVAT
Place one hand flat against costovertebral angle and strike with fist of other hand with enough force to make a thud.
