Steps
1) Inspection
2) Auscultation
3) Percussion
4) Palpation
Cullen sign
ecchymosis around umbilicus secondary to hemorrhage
Grey Turner Sign
flank ecchymosis secondary to hemorrhage
Normal bowel sounds
5-34 clicks or gurgles per minute
abnormal bowel sounds
high pitched
decrease/absent
Vascular sounds
- abdominal aorta, iliac, renal and femoral arteries
- listen for bruits with bell
Tympany
found in majority of the abdomen, caused by air-filled viscera
Dullness
flat sound without echoes, heard over solid organs
- liver and spleen
- fluid in peritoneum or feces gives dull note
Percussion of liver
-expected to be 6-12 cm at the mid-clavicular line on the right
Percussion of spleen
-expected from ribs 6-10 at the mid-axillary line on the left
Light Palpation
use tips of fingers to lightly touch the skin, up to 1cm depth in all four quadrants
Moderate Palpation
use fingers or side of hands to lightly touch the skin, 2-3cm depth in all four quadrants
Deep Palpation
use fingers and palmar surface of the hand to palpate more than 3cm in all four quadrants
Spleen Palpation
- place left hand over and around patient to support and press forward the lower left rib cage
- place right hand below left costal margin, while gently pressing inward, try to feel the tip of the spleen
- normal spleen should NOT be palpable
Kidney Palpation
- place cephalad hand behind patient, just below and parallel to 12th rib, presses anteriorly
- place caudad hand just below the costal margin in the RUQ/LUQ respectively, press down firmly and deeply at the peak of patient’s inspiration
Aorta Palpation
- palpate just above umbilicus, slightly to left of midline
- estimate the width of the aorta
- expected 2-3 cm in width, pulsation in an anterior-inferior direction
- unexpected >3cm in width, prominent lateral pulsation
Visceral Pain
- secondary to distention, stretching or contracting of hollow organs, stretching the capsule of solid organs or organ ischemia
- usually felt in the midline at the level of the structure involved
- not localized
Parietal (Somatic) pain
- secondary to inflammation in the parietal peritoneum
- usually constant and more severe than visceral pain
- localized
- aggravated by movement or coughing
- alleviated by remaining still
Rebound Tenderness
- pain upon removal of pressure, rather than application of pressure to the abdomen
- indicates peritoneal inflammation
Guarding
-voluntary tightening of abdominal muscles secondary to pain
Rigidity
-abdomen is hard, involuntary reflex contraction of abdominal wall
McBurney’s Point
- rebound tenderness or pain 1/3 of the distance from the ASIS to the umbilicus
- indicated possible appendicitis
Rovsings Sign
- pain in the RLQ upon palpation in the LLQ
- indicates possible appendicitis
Iliopsoas Muscle Test
- place hand above patients right knee and ask patient to raise thigh against resistance, then turn patient onto their side and extend right leg at the hip
- increased abdominal pain is a + test; indicates irritation of psoas muscle from inflammation of appendix
- low sensitivity
