Abdominal Examination Details

Abdominal Examination Technique

• Initial Preparation

  • Handwashing

  • Essential first step before any examination.

  • Patient Positioning

  • Ensure the patient (Daniel) is positioned comfortably; head towards one end, feet towards the other.

  • Daniel is wearing a gown; proper draping is crucial to maintain patient dignity and comfort.

• Proper Draping

  • The gown should be above the xiphoid process allowing full exposure of the abdomen.

  • The patient (SP) tucks the gown as needed, usually down to the appropriate area for examination.

• Inspection Phase

  • Inspect the abdomen for:

  • Rashes, scars, tumors, or protuberances.

  • Abdominal shape:

    • Domed, scaphoid, or other unusual shapes.

• Auscultation Phase

  • This is conducted immediately after inspection, before any palpation.

  • Listen in all four quadrants:

  • Quadrants:

    • Right Upper Quadrant

    • Left Upper Quadrant

    • Left Lower Quadrant

    • Right Lower Quadrant

  • Duration: Listen for 3-4 seconds in each quadrant.

  • Important Note:

  • Absence of bowel sounds can only be declared after listening for two minutes without any sounds.

• Palpation Phase

  • Light Palpation

  • Assess for tenderness or masses in each quadrant.

  • Deep Palpation

  • Use left hand for support, palpating with the right hand deeper in each quadrant.

  • Liver Examination:

  • Palpate the liver by placing fingers under the right upper quadrant and pushing upwards towards the liver.

    • A normal liver may be felt about 1-1.5 inches below the costal margin.

  • Spleen Examination:

  • Similar technique for the spleen in the left upper quadrant, pushing diagonally towards the spleen.

    • Normal individuals typically do not feel the spleen unless pathological conditions are present (e.g., mononucleosis).

• Percussion Phase

  • Conduct routine percussion in all quadrants.

  • Best percussion sound is found in the epigastric area (timpani).

• Aortic Aneurysm Examination:

  • In a high-risk patient (e.g., 70-year-old smoker), check for aortic enlargement midway between the xiphoid process and umbilicus.

  • Normal aorta size: approx. 2.5 - 3 cm; concern for aneurysm if > 5 cm.

  • Listen for bruits at the same location using a stethoscope.

  • Renal arteries are assessed farther out from the midline at the diaphragm level on either side.

• Murphy's Sign Test:

  • Indicated if gallbladder pathology is suspected, especially in a female with an appropriate history (e.g., obesity).

  • Procedure:

  • Diagonally palpate through the liver while the patient takes a deep breath.

  • A positive Murphy’s sign occurs if the patient stops inhaling due to pain, indicative of gallbladder inflammation.

• Rebound Tenderness Test:

  • Important for assessing appendicitis.

  • Procedure:

  • Press deeply on the abdomen then quickly release.

  • Positive rebound tenderness occurs if pain upon release is greater than pain on palpation.

• Rovsing's Sign:

  • A sign of contralateral rebound tenderness.

  • Procedure:

  • Palpate the left lower quadrant and ask if there is pain elicited in the right lower quadrant upon release.

• Lloyd's Sign:

  • Used when suspecting kidney irritation (pyelonephritis or stones).

  • Procedure:

  • Percuss around the lower ribs with a light fist tap.

  • Positive if pain is elicited in the area.

• Ascites Examination:

  • Signs of fluid buildup due to cirrhosis or portal hypertension.

  • Shifting Dullness Test:

  • Observe percussion tones while the patient is on each side; tympanic sounds above fluid levels.

  • Fluid Wave Test:

  • The patient places a hand down on the abdomen, while the examiner pushes down and catches the fluid wave on the opposite side to move fluid across the abdomen.

• Conclusion of Examination

  • Final notes regarding the overall assessment.

  • A humorous mention of a rectal exam without an actual demonstration, noting the completion of the session.