Abdomen

Year 1 Year 2 Year 3 Do: Do: Do: 1. Inspect • Abdominal wall and flanks for contour, • Percuss for and for fluid wave in • Assess for Murphy’s sign in patients suspected of masses, patients with abdominal distention to detect having . This is done by palpation venous pattern and movements . of the right upper quadrant with steady • Shifting dullness is determined by percussing pressure asking the patient to inhale deeply. 2. Auscultate circumfrentially on the and • Assess for signs of peritonitis in appropriate • For presence of bowel sounds and for presence of determining the transition points between patients by assessing for rebound tenderness. bruits if arterial insufficiency suspected (flanks, resonance and dullness (these spots are This is done by abruptly withdrawing the femoral and mid-abdomen with bell) marked on each side). The patient is rolled on hand after palpation of the abdomen. their side and again percussed as above to Increased pain or wincing is indicative of 3. Percuss determine if this transition point has peritonitis Know • along mid-clavicular line to determine the “shifted”. • A positive Murphy sign is pain causing an abrupt distance below the costal margin • Fluid wave is determined by having an assistant halt of inspiration with palpation of the right • All four quadrants including above symphysis pubis place the edge of their hand on the mid upper quadrant. This is indicative of for bladder distention and costovertebral abdomen. Palpate gently at the flank with one cholecystitis. angle for tenderness hand while quickly thumping the other flank • McBurney’s point is located roughly 1/3 the with the other hand. Sensing a shock wave distance from the right anterior superior iliac 4. Palpate with the palpating hand is indicative of spine to the umbilicus. Tenderness at this • Palpate the entire abdomen, superficially first then ascites. spot is indicative of until rupture deep using the bimanual technique • Palpate for abnormal masses and generalized peritonitis supervenes. recognizing all four quadrants • A positive psoas sign is pain when the right hip is • Liver for enlargement, tenderness and consistency Know: forcefully flexed against resistance. This may • Spontaneous bacterial peritonitis often does not indicate acute appendicitis. • Spleen using bimanual technique in right lateral present with peritoneal signs. • Peritoneal inflammation can be identified by: decubitus guarding, abdominal rigidity, or pain with • Kidneys using bimanual technique percussion. • Aorta Know: • Patients with tense abdominal muscles can be relaxed by supporting bent knees with a pillow. • Normal liver span at mid-clavicular line is 6-12 cm.

• The spleen is typically not palpable in normal patients and in thin patients the kidneys are often palpable.