FIN Exam 2: Abdominal Exam

Sequence for abdominal exam

1. Inspection

2. Auscultation

3. Percussion

4. Palpation

Why is auscultation done before percussion and palpation when performing an abdominal exam?

Percussion/palpating could make the internal structures jostled around/move and stimulate GI movement before being able to assess base GI sounds (e.g., stimulate peristalsis)

Musculature of abdomen

Organs of the GI tract

Preparation for an abdominal exam (5 steps)

1. Ask whether the patient needs to void (if so let them go before exam)

2. Place patient in supine position with knees slightly flexed (pillow under knees for comfort)

3. Examiner should stand on patient’s right side

4. Raise bed to a comfortable working position

5. Expose abdominal area

Label the parts of the abdomen

Label the contours, and what should you observe

How to auscultate for bowel sounds

• Use diaphragm of stethoscope

• Begin in RLQ and proceed through each quadrant in clockwise direction

• To note: presence, character, and frequency of bowel sounds

Borborygmus

a rumbling or gurgling noise made by the movement of fluid and gas in the intestines

• normal GI sounds

How to auscultate for bruits in abdomen

• Note locations of arteries in relation to umbilicus

• Auscultate over the arteries using the bell of the stethoscope

• If present, note locations, pitch, and timing of bruit

How to percuss abdomen

• Percuss in all four quadrants using zig-zag pattern

• Note predominant sound (tympani) and areas of dullness

Where will dullness be heard during percussion of the abdomen? (6)

• Dense organs

• Descending colon (if stool is present)

• A full bladder

• Adipose tissue

• Fluid

• Mass

How to perform light palpations on the abdomen

• Perform light palpation in all four quadrants

• Depress skin about 1 cm

• Make a gentle rotary motion with fingers

• Lift fingers and proceed to next location in clockwise direction

What should you assess for when doing light palpitations on the abdomen?

• Muscle guarding

• Rigidity

• Tenderness

How to do deep palpations on the abdomen

• Perform deep palpation in all four quadrants

• Depress about 5-8 cm (2-3 inches)

• Palpate all areas of abdomen

What should you assess for when doing deep palpitations on the abdomen?

• Tenderness

• Masses

• Location

• Consistency

• Size of any organs

Normally palpable structures???

Rebound tenderness

characterized by pain that is felt upon the release of pressure rather than during the application of pressure to the abdomen

How to perform a rebound tenderness exam

Perform at end of exam

1. Hold hand perpendicular to abdomen

2. Push down slowly and deeply, then lift up quickly

3. There should be no pain on release of pressure

What does pain after deep palpation indicate?

Peritonitis or appendicitis