Abdomen

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General

  • Position patient and drape
  • Use the correct terminology for locations on the abdomen
  • Ask patient to point to areas of pain and examine that area last

Inspection

  • Look for scars, striae, hernias, vascular changes, lesions, or rashes
  • Look for pulsations or peristalsis
  • Observe the abdominal contour

Auscultation

  • Listen until bowel sounds are heard or for a full minute
  • Report sounds as increased, decreased, or normal

Auscultation for Bruits

  • Auscultate for aorta
  • Auscultate for renal arteries
  • Auscultate for iliac arteries

Percussion

  • Percuss in all 4 quadrants
  • Outline areas of dullness and tympany
  • Percuss liver span in midclavicular line
  • Percuss for splenic dullness at the last interspace in the left anterior axillary line

Light Palpation

  • Lightly palpate in all 4 quadrants and the midline
  • Observe for signs of discomfort

Deep Palpation

  • Deeply palpate in all 4 quadrants and the midline
  • Identify organ enlargement or other masses if present

Liver and Aorta

  • Palpate for the liver
  • Palpate for the aorta and determines width

Palpation of the Spleen

  • Position yourself on patient's right
  • Lift patient's left flank
  • Palpate at left costal margin
  • Ask patient to take a deep breath
  • Finish palpation

Special Considerations: Rebound Tenderness

  • Warn patient
  • Slowly press abdomen on the side of reported pain
  • Quickly release pressure
  • Observe for signs of discomfort

Special Considerations: Liver Scratch Test

  • Place diaphragm of stethoscope over upper margin of liver
  • Lightly scratch the skin below the anticipated lower edge of the liver
  • Methodically scratch higher until sound is magnified by the mass of the liver

Special Considerations: Costovertebral Tenderness

  • Warn patient
  • Place hand over CV angle
  • Hit smartly with other hand
  • Observe for signs of discomfort
  • Repeat on other side

Special Considerations: Shifting Dullness

  • Percuss level of dullness
  • Ask patient to roll on side
  • Percuss new level of dullness
  • Repeat on other side

Special Considerations: Leg Signs for Appendicitis

  • Ask patient to raise right leg against resistance (Psoas Sign)
  • Raise and internally rotate right leg with knee flexed (Obturator Sign)

ONLINE PHYSICAL EXAM TEACHING ASSISTANT

The UF College of Medicine Harrell Center