You must auscultate abdomen before percussion or palpation

Sound heard when percussing abdomen?

Tympany

Displaced umbilicus could mean what?

Pregnancy - normal

Abdominal mass, distended bladder

Hernia in children

Draining umbilicus?

Infection or complication post laparoscopic surgery; notify physician ASAP

Abdominal pulsations could be?

In thin patients, normal abdominal aorta

Abnormal - could mean aortic aneurysm or increased pulse pressure

Peristaltic activity could be gastroenteritis or an obstruction

Hyperactive bowel sounds?

Gastroenteritis and diarrhea

Hypoactive bowel sounds?

Folling abdominal surgery or in end-stage obstruction

Absent bowel sounds?

Paralytiz Ileus - notify physician immediately

Normal rate of bowel sounds?

5-20 per min

When dullness is heard in abdomen

Normal - Over the liver and spleen, over stool in colon in LLQ.  (Ask when patient last had a bowel movement)

Abnormal - Enlarged uterus, distended bladder, ascites

How to percuss & find the liver

start at umbilicus and go up along the right MCL, when tympany becomes dullness you have found the lower border, then go down from the 4th intercostal space until resonance becomes dullness.  Distance between top and bottom should be 5-10 cm, length should be 4-8 cm.

Where is spleen percussion

Stomach percussion

Where and what sound?

Dullness means?

Left costal margin & the midsternal line below xiphoid process.

Tympany

Dullness could be a mass or food after a meal

Don't palpate abdomen if possible ....

appendicitis, dissecting abdominal aortic aneurysm, polycystic kidneys and transplanted organs.

Don't drag or slide your hand when palpating abdomen.  Lift and move

Purpose of abdominal palpation

check for tenderness and masses

Two types of rebound tenderness

(deeply press abdomen and release quickly.  Pain is referred to as rebound tenderness)

Blumberg's sign

Both are classified as this

McBurney's point - 1-2 inches above the anterosuperior iliac spine between umbilicus and ilium

Rovsing's sign - LLQ indicates appendicitus

Ascites occurs in ...

Fluid settles if patient lays on their side

congestive heart failure, cirrhosis, renal failure & many types of cancer

Psoas sign test for? How is it performed?

Appendicitus

Place your left hand just above patients right knee, have patient raise knee to hand - pain indicates psoas sign, & possible appendicitus.

Murphy's Sign

Indicates cholecystitis

Pain when palpating liver

Appendicitus

Define?

Pain?

Cause?

- Inflammation of appendix

- RLQ; sudden onset

- Obstruction, (fecal stone)

GERD

Define?

Pain?

Cause?

- Backflow of acid from stomach to esophagus

- Heartburn, chest pain

- Food intake, lying down after meals

Gastritis

Define?

Pain?

Cause?

- Inflammation of mucosal lining of stomach

- Epigastric pain

- NSAIDS, alcohol abuse, stress, infection H. pylori, autoimmune responses

Stereognosis

Identify an object without seeing it

Graphesthesia

Perceive writing on skin

Topognosis

Identify an area of the body that has been touched

Meningeal Assessment

Lean head forward touching chest, observe ROM and for pain