Abdominal Exam

1. Abdominal Exam • Inspection • Auscultation • Percussion • Palpate percussion includes percussion of liver span, light and deep palpation, palpation of liver edge, spleen tip, kidneys, and aorta. The abdominal exam is done with the patient supine at 90o Order of exam is critical. Auscultate BEFORE palpating!

2. ABDOMEN: Inspection There should be adequate exposure of the abdomen for proper inspection. The patient should be exposed from the inferior chest to the anterior iliac spines bilaterally.

3. 124: Auscultation • Auscultation can be done with the diaphragm or the bell; most examiners use the diaphragm. You should listen for at least 10-15 seconds and note the pitch and frequency of bowel sounds. If you do not hear any bowel sounds, you should listen for a full two minutes before you can state that the patient does not have any bowel sounds. Bowel sounds should occur from every other second to every 12 seconds. • Note: During the abdominal exam auscultation is done before palpation

4. Percussion 125-126 Percussion: the left and right abdomen should be percussed above and below the umbilicus. Most examiners will percuss 8 or more areas.

5. Percussion: Liver span The liver span is estimated by percussion. Remember that it is easier to hear the change from resonance to dullness – so proceed with percussion from areas of resonance to areas of dullness. Upper border: In the midclavicular line start percussing in the chest moving down towards the abdomen about ½ to 1 cm at a time. Note where the percussion notes change from resonate to dull. Lower border: In the midclavicular line begin percussion below the unbillicus and proceed upward until dullness is encounter. The distance between the two areas where dullness is first encountered is the liver span. Liver span is normally 6 to 12 cm in the midclavicular line.

6. Liver Span: Scratch Test Start in the same areas above and below the liver as you would with percussion. Instead of percussing lightly, scratch moving your finger back and forth while listening over the liver. Since sound is conducted better in solids than in air, when the louder sounds are heard you are over the liver. Mark the superior and inferior boarders of the liver span in the midclavicular line

7. Abdominal Palpation 128, 129. Palpate lightly in all 4 quadrants. Press down around 1 cm. Remember to look at the patient’s face during palpation to see if any tenderness is elicited

8. Palpation: Deeply, all 4 quadrants One should use two hands. Press down around 4 cm

9. Palpation: Liver Stand on the pt’s right side. Place your left hand behind the patient’s R side under the 11th and 12th rib area. Press upward with the L hand. Place your R hand on the pt’s abdomen well below where you percussed the liver edge

10. 130-131: Palpation of Liver: Alternative Method It is acceptable during palpation of the liver to use both hands to palpate abdomen. You use the fingers of one hand to palpate and the other hand is used to apply pressure to the dorsum of the other hand. Thus the hand you are using to palpate does not need to be used to apply pressure.

11. 132-133: Palpation: Spleen • Palpation: Spleen (correctly - position, breaths, palpating deepest full inspiration, 1 hand under L side, 1 feeling) • Palpation: Spleen (if not palpable, R lateral decubitus)

12. PALPATION OF SPLEEN Right lateral decubitus

13. 135-136: Palpation of Kidneys R L Right kidney (take a deep breath, capture kidney, exhale, slowly release kidney Left kidney (take a deep breath, capture kidney, exhale, slowly release kidney)

14. 137: Palpation: For abdominal aorta Palpation: For abdominal aorta (to feel both the left and right walls of the aorta) In correct order: Inspection, auscultation, percussion and palpation Abdominal Examination was done at 0.