Abdominal Exam

Question 1

General components of abdominal exam

Answer 1

1. Inspect
2. Auscultate
3. Percuss
4. Palpate
5. Rebound/CVA tenderness

Question 2

abdominal inspection technique

Answer 2

 Patient supine, expose abdomen from sternum to pubis with gown/drape to maintain modesty
 Skin: color, lesions, scars, dilated veins
 Size, contour and symmetry
 With patient’s head lifted

Question 3

abdominal auscultation technique

Answer 3

Auscultate (always auscultate before percussion/palpation):
 Bowel sounds(all four quadrants, 5-10 secs each)
 Bruits (renal and aortic)

Question 4

abdominal percussion technique

Answer 4

 All four quadrants: tympany, dullness

 Liver span (may use scratch test)

Question 5

abdominal palpation technique

Answer 5

Palpate:
  Light palpation all four quadrants
  Deep palpation all four quadrants
  Check for Murphy’s sign
  Palpate McBurney’s point
  Test for Rovsing’s sign
  Liver, spleen, aorta

Question 6

Liver span technique

Answer 6

• Begin in the lower right quadrant (want to be sure to start low enough to detect enlargement if present)
• Percuss up the midclavicular line until dullness is heard, this is the lower liver border
• Then, find an area of lung resonance on the right side of the chest, may need to displace breast tissue to hear
• Percuss down the midclavicular line until dullness is heard, this is the upper liver border
• Normal liver span is 6-12 cm (men typically have larger spans than women)

Question 7

Murphy’s test technique

Answer 7

• A positive test is indicative of hepatic or gallbladder inflammation
• Palpate below the liver margin at the lateral border of the rectus abdominis muscle for gall bladder
• Ask patient to take a deep breath
• As the inflamed gall bladder comes in contact with the examiners fingers, the patient will experience pain and stop inspiration

Question 8

McBurney’s point technique

Answer 8

• Press firmly with fingers of right hand at 90°angle to abdomen in the RLQ, release quickly and assess patient’s reaction
• Pain w/rebound tenderness over the McBurney point suggests appendicitis

Question 9

Rovsings sign technique

Answer 9

• Press firmly with fingers of right hand at 90°angle to abdomen in the LLQ, release quickly and assess patient’s reaction
• LLQ is assessed but pain felt on right side - aka referred rebound tenderness