Abdomen Assessment Sequence-1 PDF

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Summary

Assessment...

Description

Abdomen Assessment Sequence

Normal

Common Abnormal

Inspection

Inspect the abdomen shape, contour, symmetry, skin of abdomen, rashes or ecchymosis

Flat, non-distended, symmetrical, no lesions, scars. Silver or flesh tone striae, no rashes or ecchymosis

Auscultate

Auscultate for bowel sounds all 4 quadrants. Note frequency and character of sound Auscultate for arterial sounds (bell of the stethoscope) aorta, iliac, renal, and femoral arteries Percuss all 4 quadrants for fluid, masses or distention

Present in all 4 quadrants, normoactive (sounds every 5-15 seconds) Unable to appreciate a bruit

Scaphoid or protruding, distended, asymmetrical, bulges. Surgical scars (describe location), pinkpurple striae, rash (describe), presence of ecchymosis Absence, hypoactive or hyperactive

Percuss kidneys (posterior)

No CVA tenderness

Dull over suprapubic region, dull throughout the 4 quadrants Pain with percussion

Percuss and measure liver span Right MCL Percuss for Spleen L AAL 6th ICS Light palpation all 4 quadrants for tenderness, masses, bulges. Deep palpation all 4 quadrants for masses Palpation of aortic pulsation

Expected liver span 6-12 cm Tympany present

Liver span 2-3 cm below costal margin Dullness

No tenderness, masses or bulges

Tenderness with light palpation, rigidity, voluntary guarding Mass present-describe location Thrill present

Percussion

Palpation

Specialized Testing: Driven by patient presentation Suspected RUQ pain

Suspicion of presence of Fluid in abdomen

Abdomen pain suspected

Tympanic tone heard throughout

No masses present

Palpate the liver border Palpate for the spleen

Palpable in thin individuals no thrill Liver border smooth Normally not palpable

Palpate for kidneys

Normally not palpable

Palpate for Gallbladder tenderness-Murphy’s Sign

No tenderness on palpation

Shifting Dullness Fluid wave

Tympany heard throughout No fluid wave

Rebound tenderness

Reports less pain when

Bruit

Irregular, enlarged Palpable, firm, tender to palpation Tenderness

Tenderness an pain reported, gallbladder may be palpable, Patient stops inhalation due to pain Palpable and non-tender Shift from tympany to dull with shift in position Ascites present-fluid wave is visualized Reports more pain when

to be caused by inflammation

McBurney’s Sign Rovsig’s Sign Psoas Muscle Test-patient raise right leg while examiner applies downward pressure on right thigh Obturator Muscle TestPatient flexes right hip and knee 90 degrees, examiner rotates leg medially and laterally Cough test

pressure released Absence of pain Absence of referred rebound tenderness No pain

pressure released Pain reported with palpation Pain in RLQ when palpating LLQ Reports RLQ pain

No pain

Pain in hypogastric area

No pain in abdomen with Cough

Points to painful area when coughing...