Assessment

Question 1

Inspection

Answer 1

o Colour:
 Jaundice (yellow): Liver disease or bile obstruction.
 Pallor: Anemia or blood loss.

o Contour:
 Flat, scaphoid (malnourishment), or distended (ascites, obstruction).

Check pulsations:
o Rationale: Normal pulsations may be seen in thin patients. Exaggerated pulsations suggest an aortic aneurysm (epigastric area).

Check for visible masses or nodules:
o Rationale: Visible masses can be tumors or hernias.

o Skin:
 Striae (rapid weight changes or Cushing’s syndrome).
 Scars (previous surgeries or trauma)

Check symmetry:
o Rationale: Asymmetry may indicate masses, hernias, or organ enlargement.

Look for visible peristalsis:
o Rationale: Peristalsis might be visible in thin patients but can indicate intestinal obstruction in others.

Observe respiratory movements:
o Rationale: Respiratory patterns can highlight abnormalities like peritoneal irritation.

Inspect the umbilicus:
o Rationale: Everted umbilicus suggests ascites or an umbilical hernia

Question 2

Auscultation

Answer 2

1. Perform before percussion or palpation:
   o Rationale: Prevents stimulation of bowel sounds which could alter findings.
2. Auscultate bowel sounds in all four quadrants:
   o Rationale: Bowel sounds reflect GI motility. Start at the RLQ where sounds are most likely present.
3. Use the bell to auscultate vascular sounds (aorta, renal, iliac, femoral arteries):
   o Rationale: Bruits indicate turbulent blood flow, suggesting stenosis or aneurysm.

Question 3

Percussion

Answer 3

• Rationale: Differentiates between air, fluid, and solid masses.
• Diseases:
  o Hepatomegaly: Enlarged liver (hepatitis, fatty liver).
  o Splenomegaly: Enlarged spleen (infection, trauma).

 Tympany: Normal over air-filled areas (stomach, intestines).
 Dullness: Indicates solid organs (liver, spleen) or fluid (ascites, masses).

1. Percuss all four quadrants:
   o Rationale: Tympany should predominate due to air in the intestines.
2. Percuss the stomach (gastric bubble):
   o Rationale: Hyper-resonance indicates a gas-filled stomach.
3. Percuss the bladder:
   o Rationale: Tympany suggests an empty bladder; dullness indicates fullness.
4. Determine liver span:
   o Rationale: Liver span (6–12 cm) helps assess liver size and possible hepatomegaly.
5. Percuss the spleen:
   o Rationale: Dullness in the left midaxillary line (9th–11th ribs) suggests splenic enlargement.
6. Perform fist percussion on kidneys:
   o Rationale: Sharp pain indicates inflammation (pyelonephritis) or stones.

Question 4

Palpation

Answer 4

• Rationale: Detects tenderness, organ size, or masses.
• Findings:
  o Tenderness in RLQ: Appendicitis.
  o Rebound tenderness: Peritonitis.
  o Mass in RUQ: Hepatomegaly, gallbladder inflammation.

1. Light palpation in all quadrants:
   o Rationale: Assesses for tenderness, masses, and surface characteristics.
2. Deep palpation:
   o Rationale: Identifies organ size, location, and abnormalities (masses, tenderness).
3. Liver palpation:
   o Rationale: Determines liver edge and size. Enlarged liver (hepatomegaly) suggests hepatitis or fatty liver.
4. Aorta palpation:
   o Rationale: Measures aortic width (normal: 2.5–4 cm). Widening indicates aneurysm.

Question 5

Special Tests

Answer 5

• Murphy’s Sign:
  o Procedure: Palpate RUQ while patient inhales.
  o Positive: Pain suggests gallbladder inflammation (cholecystitis).
• Rebound Tenderness:
  o Procedure: Press down and release quickly.
  o Positive: Peritonitis or appendicitis.
• Iliopsoas Test:
  o Procedure: Patient raises leg against resistance.
  o Positive: Pain in RLQ suggests appendicitis.
• Renal Punch:
  o Procedure: Tap lightly over kidneys.
  o Positive: Pain indicates kidney infection (pyelonephritis).

Question 6

Health Promotion

Answer 6

• Rationale: Prevention improves patient outcomes.
• Education Areas:
  o Hepatitis Risk: Safe sex, hygiene, vaccinations.
  o Nutrition: Balanced diet to prevent obesity and malnutrition.
  o Lifestyle Changes:
   Smoking cessation: Reduces risk of gastric ulcers and cancer.
   Alcohol reduction: Prevents liver damage.

Question 7

Superficial Palpation

Answer 7

• Purpose:
  o Detect tenderness.
  o Identify superficial masses.
• Technique:
  o Use light pressure, limited to the flexion at the metacarpal-phalangeal joint.
  o Warm hands to avoid misinterpretation of discomfort as pain.
  o Palpate systematically through all nine abdominal regions:
   Epigastric, umbilical, suprapubic.
   RUQ, LUQ, RLQ, LLQ.
   Right and left hypochondriac and lumbar regions.
• Assessment:
  o Observe for tenderness and differentiate:
   Tenderness: Local pain from inflammation or irritation.
   Guarding: Voluntary tightening due to discomfort.
   Rigidity: Involuntary muscle contraction, often from peritonitis.
   Rebound tenderness: Pain upon release, indicating peritoneal inflammation (e.g., appendicitis).

Question 8

Deep Palpation

Answer 8

• Purpose:
  o Identify and characterize deeper masses.
• Technique:
  o Apply consistent, firmer pressure compared to superficial palpation.
  o Move through the same nine regions.
• Assessment:
  o If a mass is detected:
   Describe size, shape, consistency, mobility, and tenderness.
   Document findings for the examiner.

Question 9

Percussion for Ascites (Fluid in the Peritoneal Cavity)

Answer 9

1. Principle:
   o Fluid sinks, and gas rises due to gravity.
2. Steps:
   o Percuss the top of the abdomen (resonant sound) and flanks (dull sound) while supine.
   o Test shifting dullness:
    Ask the patient to lie on their side and percuss again.
    Fluid shifts to the dependent side, producing dullness.
    Air moves to the upper side, producing resonance.
   o Test fluid wave or thrill:
    Assistant places hands down the midline of the abdomen.
    Tap one flank sharply while the opposite flank is palpated.
    Positive test: Wave transmitted through the fluid to the other side.