Abdominal Exam Procedures and Findings

Abdominal Exam: Comprehensive Notes

Patient Preparation and Positioning

• Patient Identification: The patient is Mrs. Chua.

• Gown Adjustment: Instruct the patient to raise her gown just below her breasts to expose the abdomen fully. The examiner will also lower the gown as needed for inspection.

• Muscle Relaxation: Have the patient bend their knees. This action helps to relax the abdominal muscles, facilitating a more effective and comfortable examination.

Inspection of the Abdomen

• General Inspection: Observe the abdomen for any:

  • Obvious masses: Localized swellings or protuberances.

  • Hernias: Protrusions of an organ or tissue through an abnormal opening, often visible as a bulge.

  • Pulsations: Visible rhythmic throb, particularly important to note in the epigastric area, which could indicate a dissecting aortic aneurysm or prominent abdominal aorta.

• Specific Hernia Check (Patient Effort): Ask the patient to bring their head up. This action increases intra-abdominal pressure, which can make subtle hernias (e.g., umbilical, incisional) more visible or palpable.

Auscultation of the Abdomen

• Bowel Sounds:

  • Procedure: Auscultate a minimum of four abdominal quadrants.

  • Expected Finding: "Positive bowel sounds in all four quadrants" indicates active gut motility, which is a normal finding.

• Aortic Bruits:

  • Instrument: Use the bell of the stethoscope.

  • Location: Auscultate over the aorta, typically in the epigastric region.

  • Expected Finding: "No bruits" is a normal finding. The presence of a bruit (a whooshing sound) could suggest turbulent blood flow, potentially due to aortic stenosis or an aneurysm.

Percussion of the Abdomen

• General Quadrants: Percuss all abdominal quadrants to assess for gaseous distension, fluid (ascites), or organ enlargement.

• Liver Size Assessment:

  • Purpose: To determine the approximate vertical span of the liver.

  • Normal Range: The typical liver span is between approximately $6$ and $12$ cm at the midclavicular line. A span outside this range may indicate hepatomegaly (enlarged liver) or a small liver.

Palpation of the Abdomen

• Light Palpation:

  • Procedure: Gently palpate all four quadrants.

  • Patient Communication: Continuously ask the patient if they experience any discomfort or tenderness during palpation.

• Deep Palpation:

  • Procedure: Follow light palpation with more deliberate, deeper palpation of the quadrants.

  • Purpose: To detect masses, organomegaly, and deeper tenderness not evident with light palpation.

• Liver Palpation:

  • Technique: Instruct the patient to breathe in deeply and then exhale. This maneuver helps to push the liver downwards, making its edge more palpable under the costal margin.

• Spleen Palpation:

  • Technique: Similar to liver palpation, ask the patient to breathe in and out. The spleen is typically not palpable unless enlarged, and this maneuver aids in its detection if it is.

• Kidney Palpation:

  • Technique: Palpate for the kidneys, usually deeply in the flanks. Normal kidneys are often difficult or impossible to palpate.

• Aortic Palpation:

  • Procedure: Palpate the abdominal aorta, typically in the epigastric region, to assess its size.

  • Expected Finding: "Very normal" size indicates the aorta is not dilated (i.e., no aneurysm detected through palpation).

Examination of the Inguinal Region

• Patient Positioning: Have the patient straighten their legs.

• Exposure: Instruct the patient to hold their underwear to the side to provide adequate exposure of the inguinal area.

• Unilateral Examination (Right Side Example):

  • Palpation and Inspection: On one side (e.g., right), check for and palpate:

    • Femoral hernias: Protrusions in the femoral canal.

    • Femoral pulses: Assess amplitude and rhythm of the pulse.

    • Inguinal nodes: Palpate for enlarged or tender lymph nodes, which can indicate infection or malignancy.

  • Auscultation: Auscultate for femoral bruits, which could indicate peripheral arterial disease or stenosis in the femoral artery.

• Contralateral Examination (Left Side Example):

  • Order: The examiner starts by auscultating first on the second side.

  • Palpation and Inspection: Repeat the checks for femoral pulses, femoral hernias, and inguinal nodes on the other side.

This structured approach ensures a thorough assessment of the abdominal and inguinal regions, covering key aspects of organ integrity, vascular health, and potential pathology.