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 90 o.
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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!
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.
Percussion: the left and right abdomen should be percussed above and below the umbilicus. Most examiners will percuss 8 or more areas.
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.
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
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
One should use two hands. Press down around 4 cm
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
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.
Right lateral decubitus
Right kidney (take a deep breath, capture kidney, exhale, slowly release kidney
Left kidney (take a deep breath, capture kidney, exhale, slowly release kidney)
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.