Percussion Physical Exam

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• [DOWNLOAD] Percussion Physical Exam | HOT

  Ask patient to take a deep breath and try to feel the liver edge as it descends. Be sure to allow liver to pass under the fingers of your right hand, note texture. Pressing too hard may interfere. Findings The normal liver may be slightly tender....

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• [FREE] Percussion Physical Exam | HOT!

  Nodules may be palpable; rock hard and umbilicated central dimple nodules suggest malignancy. Percussion During the Liver Exam The purpose of liver percussion is to measure the liver size. Technique Starting in the midclavicular line at about the...

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• Examination Of The Liver

  Definition Inspection consists of visual examination of the abdomen with note made of the shape of the abdomen, skin abnormalities, abdominal masses, and the movement of the abdominal wall with respiration. Abnormalities detected on inspection provide clues to intra-abdominal pathology; these are further investigated with auscultation and palpation. Auscultation of the abdomen is performed for detection of altered bowel sounds, rubs, or vascular bruits. Normal peristalsis creates bowel sounds that may be altered or absent by disease.

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• The Physical Examination And Health Assessment

  Irritation of serosal surfaces may produce a sound rub as an organ moves against the serosal surface. Atherosclerosis may alter arterial blood flow so that a bruit is produced. Palpation is the examination of the abdomen for crepitus of the abdominal wall, for any abdominal tenderness, or for abdominal masses. The liver and kidneys may be palpable in normal individuals, but any other masses are abnormal. Technique Inspection The abdomen is inspected by positioning the patient supine on an examining table or bed. The head and knees should be supported with small pillows or folded sheets for comfort and to relax the abdominal wall musculature.

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• Percussion (medicine)

  The entire abdominal wall must be examined and drapes should be positioned accordingly. The patient's arms should be at the sides and not folded behind the head, as this tenses the abdominal wall. Good lighting is essential, and it is helpful to have tangential lighting available, for this can create subtle shadows of abdominal wall masses. First, the general contour of the entire abdominal wall is observed. The contour should be checked carefully for distention and note made as to whether any distention is generalized or localized to a portion of the abdomen. Similarly, the flanks should be checked for any bulging. The abdominal wall skin should be inspected carefully for abnormalities. Any areas of discoloration should be noted, such as the bluish discoloration of the umbilicus Cullen's sign or flanks Grey Turner's sign.

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• Abdominal Assessment: Percussion

  The skin should be inspected for striae, or "stretch marks," and surgical scars. Careful note of surgical scars should be made and correlated with the patient's recollection of previous operations. The skin of the abdomen should also be checked carefully for engorged veins in the abdominal wall and the direction of blood flow in these veins. This is performed by placing the tips of the index fingers together, compressing a visible vein. The fingertips are then slid apart, maintaining compression, producing an empty venous segment between the fingers.

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• Pulmonary Examination

  A finger is removed from one end and the vein is watched for filling. The procedure is then repeated, but the opposite finger is removed and the vein again checked for filling. Above the umbilicus, blood flow is normally upward; below the umbilicus, it is normally downward. Obstruction of the inferior vena cava will cause reversal of flow in the lower abdomen. In addition to these large dilated veins, note should be made of any spider angiomas of the abdominal wall skin. Next, the abdomen should be inspected for masses. This should be performed from several angles. It is important to differentiate abdominal wall from intra-abdominal masses. A mass of the abdominal wall will become more prominent with tensing of the abdominal wall musculature, whereas an intra-abdominal mass will become less prominent or disappear.

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• Pulmonary Exam: Percussion & Inspection

  Useful maneuvers are to have the patient hold his head unsupported off the examining table, to hold his nose and blow, or to raise his feet off the table. Abdominal wall masses are most commonly hernias either umbilical, epigastric, incisional, or spigelian , neoplasms benign and malignant , infections, and hematomas. Once a mass is determined to be intra-abdominal, its location should be described in relation to the abdominal quadrants Figure The relationship of intra-abdominal organs to these quadrants should be considered in attempting to determine the cause of the mass. The mass should be examined for movement with respiration or for pulsation with each heartbeat. Also, the mass should be observed for peristalsis, as it may well represent dilated bowel.

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• Physical Examination

  Figure Lastly, the abdominal wall should be observed for motion with respiration. Normally, the abdominal wall moves posteriorly in a symmetrical fashion with inspiration. With peritonitis, there may be localized or generalized rigidity of the abdominal wall so that this motion is absent. Auscultation The patient is positioned comfortably in the supine position as described in Inspection. The stethoscope is used to listen over several areas of the abdomen for several minutes for the presence of bowel sounds. The diaphragm of the stethoscope should be applied to the abdominal wall with firm but gentle pressure.

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• Physical Examination

  It is often helpful to warm the diaphragm in the examiner's hands before application, particularly in ticklish patients. When bowel sounds are not present, one should listen for a full 3 minutes before determining that bowel sounds are, in fact, absent. Auscultation for abdominal bruits is the next phase of abdominal examination. Bruits are "swishing" sounds heard over major arteries during systole or, less commonly, systole and diastole. The area over the aorta, both renal arteries. Rubs are infrequently found on abdominal examination but can occur over the liver, spleen, or an abdominal mass. Palpation and Percussion The patient is positioned supine with head and knees supported, as for Inspection and Auscultation. Take the history and perform inspection and auscultation before palpation, as this tends to put the patient at ease and increases cooperation. In addition, palpation may stimulate bowel activity and thus falsely increase bowel sounds if performed before auscultation.

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• Pulmonary Examination

  In addition, it will demonstrate any irregularities of the abdominal wall such as lipomas or hernias and give some idea as to areas of tenderness. Deep palpation of the abdomen is performed by placing the flat of the hand on the abdominal wall and applying firm, steady pressure. It may be helpful to use two-handed palpation Figure Here the upper hand is used to exert pressure, while the lower hand is used to feel. One should start deep palpation in the quadrant directly opposite any area of pain and carefully examine each quadrant. At each costal margin it is helpful to have the patient inspire deeply to aid in palpation of the liver, gallbladder, and spleen.

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• Castell's Sign

  In the flanks it is often helpful to elevate the flank to be examined slightly and place one hand on the lower ribs of that flank to "push" the retroperitoneal contents up to the examining hand. In this way, small renal masses that would otherwise be missed may be appreciated. Abdominal tenderness is the objective expression of pain from palpation. When elicited, it should be described as to its location quadrant , depth of palpation required to elicit it superficial or deep , and the patient's response mild or severe. Spasm or rigidity is the involuntary tightening of the abdominal musculature that occurs in response to underlying inflammation. Guarding, in contrast, is a voluntary contraction of the abdominal wall musculature to avoid pain.

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• Abdominal Exam II: Percussion | Protocol

  Thus, guarding tends to be generalized over the entire abdomen, whereas rigidity involves only the inflamed area. Guarding can often be overcome by having the patient purposely relax the muscles; rigidity cannot be. Rigidity is thus a clear-cut sign of peritoneal inflammation. Rebound tenderness is the elicitation of tenderness by rapidly removing the examining hand. Again, this is a difficult sign for the beginning examiner to master. The most common error is to remove the hand very quickly with an exaggerated motion and thus startle the patient. All that needs to be done is smoothly but quickly to lift the palpating hand off the abdomen and observe for pain, facial grimace, or spasm of the abdominal wall. Both tenderness and rebound tenderness may be elicited by palpation in a different quadrant.

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• Peritonitis Physical Examination - Wikidoc

  Thus, palpation of the left lower quadrant may produce tenderness and rebound tenderness in the right lower quadrant in appendicitis Rovsing's sign. This is called referred tenderness and referred rebound. When abdominal masses are palpated, the first consideration is whether the mass is intra-abdominal or within the abdominal wall. This can be determined by having the patient raise his or her head or feet from the examining table. This will tense the abdominal muscles, thus shielding an intra-abdominal mass while making an abdominal wall mass more prominent. If the mass is intra-abdominal, important points are its size, location, tenderness, and mobility.

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• Abdominal Exam II: Percussion

  Palpation and percussion are used to evaluate ascites. A rounded, symmetrical contour of the abdomen with bulging flanks is often the first clue. Palpation of the abdomen in the patient with ascites will often demonstrate a doughy, almost fluctuant sensation. In advanced cases the abdominal wall will be tense due to distention from the contained fluid. Gas-filled intestines will float to the top of the fluid-filled abdomen.

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• Percussion (medicine) - Wikipedia

  Thus, in the supine patient with ascites there should be periumbilical tympany with dullness in the flanks. One should mark the level of dullness on the skin and then turn the patient on one side for a full minute. A change in the level of dullness is termed shifting dullness and usually indicates more than ml of ascitic fluid. Another physical sign of ascites is demonstration of a transmitted fluid wave. The patient or an assistant presses a hand firmly against the abdominal wall in the umbilical region. The examiner places the flat of the left hand on the right flank and then taps the left flank with his right hand. In the presence of ascites, a sharp tap will generate a pressure wave that will be transmitted to the left hand.

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• Pulmonary Exam: Percussion & Inspection | Stanford Medicine 25 | Stanford Medicine

  Unfortunately, fat will also transmit a fluid wave, and there are frequent false-positives with this test. In addition to detection of ascites, percussion can be used to help define the nature of an abdominal mass. Tympany of an abdominal mass implies that it is gas filled i.

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• Castell's Sign - Wikipedia

  As you might know, medical percussion is based on the difference in pitch between the sounds elicited by tapping on the body wall. The sounds produced during abdominal percussion can help detect pathologies like organomegaly, intra-abdominal masses, and fluid accumulation. This video will illustrate the major anatomical areas to be percussed during an abdominal exam, and the steps and findings of this procedure. First, let's talk about the expected abdominal percussion sounds and their interpretations.

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• Techniques Of Physical Assessment: NCLEX-RN || Medicoguia.com

  As the air-filled bowel loops are positioned in the closest proximity to the abdominal wall, percussion over most parts of the abdominal cavity elicits a predominantly tympanic sound… Notice that this sound is relatively long, high pitched, and loud. Percussion over dense organ tissues, like the spleen or the liver, produces a dull sound… Therefore, the contrast between dullness versus tympany allows for determination of the margins of these organs and thus help in detection of conditions like hepatomegaly or splenomegaly.

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• Abdominal: Percussion

  Dull sounds are also produced on percussing areas filled with fluid and feces. Therefore, by percussing one can predict the cause of protuberant abdomen, which helps in diagnosis of conditions like ascites. With this background in mind, let's review a detailed step-wise procedure for abdominal percussion. Explain the procedure to the patient and obtain their consent before starting with the exam. Drape the patient appropriately to expose the torso area and perform light percussion over each of the nine abdominal regions. Listen to the intensity, pitch, and duration of the percussion note. Normally, tympanic sound produced by air in the bowel loops will be heard As you percuss, watch the patient's face for any signs of discomfort.

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• UC San Diego's Practical Guide To Clinical Medicine

  Ask the patient if they are experiencing any tenderness. Tenderness on percussion is abnormal and can indicate peritoneal inflammation. After abdominal area, percuss the lower anterior chest, above the costal margins. Dull sound on the right, over the liver is expected On the left, one should hear tympany over the gastric air bubble and the splenic flexure of the colon Following that, move to the area of pubic symphysis. Again, this should yield a tympanic sound…dullness indicates enlarged uterus or distended bladder. Next step is to determine the liver span. Start by locating the right midclavicular line. Starting in the area of tympany below the umbilicus, lightly percuss in the right midclavicular line moving upwards… Make a mark where the tympany changes to dullness with a skin pencil. This is the lower border of the liver. Then, starting at the nipple line, again percuss in the right midclavicular line moving downwards.

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