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Abdominal Examination -
Tactile, Visual, Auditory
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Medical words for the abdomen, pathologic terms, signs
ascites - interstitial fluid in the abdomen, often seen in patients with liver disease. Tests: "serum-ascites albumin gradient," (SAAG. You may hear the terms "exudate" and "transudate" discussed - the ascitic fluid can be tested to determine if it is a transudate (pulled from the cells through their membranes, therefore having little protein - suggests osmotic/oncotic pressures) or an exudate (released from pores or tears in cells, and having a similar high-protein composition - suggests cell damage).
colicky pain - any pain that comes in waves, which suggests a blockage in a tube, such as the stomach, intestines, bile/pancreatic duct, ureter, etc.
guarding - muscle tension, can be voluntary or involuntary, that the patient creates to protect a tender area. You can simulate guarding by tensing up as if you are about to be punched in the stomach. Involuntary guarding, or a rigid abdomen, is probably the most reliable indicator of an acute surgical abdomen. It's much more specific than rebound tenderness, which is often seen in the absence of a surgical abdomen.
hernia - a hernia is present whenever abdominal contents protrude through something that's supposed to be containing them. They can poke through the inguinal canal (inguinal hernia), along the abdominal midline between the rectus abdominus muscles (ventral hernia), out through the umbilicus (umbilical hernia), along any incision (incisional hernia), through the diaphragm and into the thorax (hiatal hernia - this specifically refers to the stomach rising through the diaphragm), etc. Hernias may or may not be symptomatic or clinically relevant.
intussusception - the "telescoping" of one portion of intestine into another portion of intestine, similar to the way a car antenna retracts. It may cause obstruction, bloating, intense pain. Usually diagnosed (and sometimes simultaneously corrected) by barium enema, although surgery is frequently required.
McBurney's point - 1/3 of the way from the ASIS (anterior superior iliac spine/crest - the hip bone) to the umbilicus. This is where the appendix is located, and where patients typically have focal tenderness as appendicitis progresses.
Murphy's sign - inspiratory arrest on subcostal RUQ (right upper quadrant) palpation, suggestive of gallbladder disease.
obturator sign - considered positive if the patient experiences RLQ pain while you flex the hip and knee and internally rotate the leg - suggests appendicitis.
psoas sign (sew-uss)- considered positive if the patient experiences RLQ pain while you provide resistance against the patient lifting the right thigh (flexing the right hip)- suggests appendicitis.
rebound - pain on rapid withdrawal of pressure - considered a "peritoneal sign," meaning that it suggests the likelihood of peritoneal inflammation.
Rosving's sign - considered positive if the patient experiences RLQ pain as you apply LLQ pressure - suggests appendicitis.
striae - aka "stretch marks" - These can occur naturally as a result of weight gain such as in pregnancy and obesity, or as the skin is stretched in bodybuilding. It can also be a sign of Cushing's disease, in which there is excessive cortisol production by the adrenals.
surgical abdomen - aka "acute abdomen" - In its most basic sense it refers to any abdomen that should be looked at and/or operated by a surgeon. Typical things that would make you classify an abdomen as "acute" would include peritoneal signs, bleeding, focal tenderness at McBurney's point, exquisite focal tenderness in any quadrant, or severe colicky pain.
torsion - aka "volvulus" - the twisting of a section of intestine, similar to wringing a towel. It can cause obstruction of the lumen, and can result in ischemia, bloating, and intense pain.
Bowel Sounds:
normoactive, hyperactive, absent, hypoactive,
rushes, volvulus, borborygmi(bore-bore-ig-me),
tinkles
FOR MORE DEFINITIVE INDIVIDUAL REGIONAL EXAMINATIONS (by specialty or problem)
Chest examination
Heart examination
Physical examination
Pulse (Pulses) Exam/Testing
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