4. On Auscultation
Auscultate the abdomen for bowel
sounds , vascular sounds and peritoneal
friction rub.
Normal findings: Audible bowel sounds,
Absence of arterial bruits, Absence of
friction rub.
7/5/2023
4
NEETHU
MOHANLAL
6. On Percussion
Percuss several areas in each of the
four quadrants to determine presence of
tympany ( gas in stomach) and dullness
over solid masses or fluid.
Percussion begins from lower right
quadrant- upper right quadrant- upper left
quadrant –lower left quadrant.
7/5/2023
6
NEETHU
MOHANLAL
9. Abdominal girth
Abdominal girth is measured by
placing a tape around the abdomen at the
level of the umbilicus.
7/5/2023
9
NEETHU
MOHANLAL
10. On Palpation
Perform light palpation first to detect
areas of tenderness and /or muscle guarding.
Systematically explore all quadrants. Ensure
that the clients position is appropriate for
relaxation of the abdominal muscles.
Normal findings: No tenderness, relaxed
abdomen with smooth ,consistent tension
7/5/2023
10
NEETHU
MOHANLAL
11. • Rovsing’s sign- Pain in the right iliac fossa
on palpation of the left side of the
abdomen
• Cough test – pain when the patient is
asked to cough
7/5/2023
11
NEETHU
MOHANLAL
13. Obturator sign
A sign of appendicitis or other
peritoneal inflammation. The internal
rotation of the right leg with the leg fixed to
90 degree at the hip and knee and a
resultant tightening of the internal
obturator muscle may cause abdominal
discomfort
7/5/2023
13
NEETHU
MOHANLAL
16. Carnett’s sign
Carnett’s sign is a finding on clinical
examination in which abdominal pain remains
unchanged or increase when muscles of
abdominal wall are tensed. The patient can be
asked to lift the head and shoulder from the
examination table to tense the abdominal
muscles.
7/5/2023
16
NEETHU
MOHANLAL
18. Murphy’s sign
A test for gallbladder disease in which the
patient is asked to inhale while the examiners
finger are hooked under the liver border at the
bottom of the rib cage. This inspiration causes
the gall bladder to descend onto the fingers,
producing pain if the gall bladder is inflammed.
7/5/2023
18
NEETHU
MOHANLAL
20. Kehr's sign
• Kehr's sign is the occurrence of acute pain in the
tip of the shoulder due to the presence of blood
or other irritants in the peritoneal cavity when a
person is lying down and the legs are elevated.
• Kehr's sign in the left shoulder is considered a
classic symptom of a ruptured spleen.
7/5/2023
20
NEETHU
MOHANLAL
25. Normal findings:
Equal size on both side of the body, No
contractures, No tremors
Abnormal findings :
Atrophy, hypertrophy, Mal position of
body part, presence of tremor
7/5/2023
25
NEETHU
MOHANLAL
26. Extremities- joints
Normal findings: No swelling, No
tenderness, crepitation or nodules, joints
move smoothly
Abnormalities: One or more swollen joints,
presence of tenderness ,swelling,
crepitation or nodules, Limited range of
motion in one or more joints
7/5/2023
26
NEETHU
MOHANLAL
27. Extremities –Muscle strength
Grade Muscle strength
0 Complete paralysis
1/5 No movement, contraction of muscle
is palpable or visible
2/5 Full muscle movement against gravity
with support
3/5 Normal movement against gravity
4/5 Normal full movement against gravity
and against minimal resistance
5/5 Normal full movement against gravity
and against full resistance
7/5/2023
27
NEETHU
MOHANLAL
28. Back and spine
Inspect for any abnormalities such as
• Kyphosis – an abnormally increased roundness
of the thoracic curve or hump – back
• Scoliosis- a lateral deformity of the spine.
• Lordosis- an abnormal increase in the lumbar
curve or sway back
• Spina bifida
7/5/2023
28
NEETHU
MOHANLAL
Place sthethsecope juz above the umblicus , a.tleast 3 min we shoulld keep to confirm bowel sounds are absent. Bowel sounds appear at 8-10 sec interval, may vary and more frequently after meals. 5-30 bowel sounds per min
Bruit- aortic area, rt hypochondrium over the liver, renal artery area
Venous hum- a humming sound may be heard between xiphisternum and the umblicus in PHTN.
friction rub- splenic or hepatic infact perihepatitis respectively.
Succssion splash- splashing sound like shaking a half filled bottle . Place one hand over the lower ribs and sshake the patient quickly and rhythmically from side to side and auscultate over the epigastrium. Heard in pyloric stenosis.
A positive Carnett's sign should broaden the differential of abdominal pain to include: hernias, irritation of intercostal nerve roots, rectus sheath hematomas, myofascial pain,
