- occurs early in mechanical bowel obstruction

- visible moving across the abdominal wall

Visible peristalsis

- normally produces a slight visible pulsation in the above the umbilicus

- amplitude increased with wide pulse pressure, tortuosity, or AAA

Abdominal Aorta

- naval protudes

- common in child until 4 yrs

- occurs in adults with ascites, pregnancy or severe emphysema

umbilical hernia

- presents as tender mass in abdominal wall above the inguinal ligaments

Spigelian hernia

- separation of abdominal muscles along the linear midline that creates a benign bulge as pt lifts their head off the exam table

- occurs often with pregnancy or obesity

Diastasis rectus

- normal sounds are intermittent, variable in intensity, and loudest when a meal is anticipated

Peristaltic sounds

- the absence of bowel sounds is characteristic of a decrease in bowel motility (intestinal ileus) and is a result of one of these two mechanisms

mechanical or paralytic (adynamic) ileus

- mechanical ileus may be caused by this

- eventually it dilates, becomes congested and edematous and ceases normal peristalsis

Bowel Obstruction

- inflammation of the bowel, ischemia of the bowel, and electrolyte abnormalities can cause this

Paralytic ileus

- the trauma of abdominal surgery can cause this kind of bowel pathology

- causes abdominal distention

Adynamic ileus (shock)

- length of time potentially needed to hear small bowel obstruction tinkles and rushes

20 minutes

- irritated bowel finding that occurs with gastroenteritis or diarrhea (also heard around mealtime)

hyperperistalsis

- before intestinal ileus occurs, a small bowel obstruction can cause these increased bowel sounds with waves of pain

borborygmi (increased peristaltic sounds)

- with high-pitched tinkles, abdominal distention and vomiting, this diagnosis is logically viable

acute small bowel obstruction

- most common source of arterial abdominal bruits

Celiac artery

- people with higher prevalence of epigastric systolic bruits

- can also be assocaited with AAA, but not necessary

women of childbearing age

radiation to flank/costvertebral angle

- finding of an abdominal bruit having both systolic and diastolic components is virtually diagnostic of this

renal artery stenosis

- bruit heard on line from umbilicus to mid inguinal ligament

common iliac artery bruit

- RUQ bruit, primarily systolic

- 14% prevalence in hepatomas

- can also be from vascular tumor of liver

liver tumor bruit

- systolic RUQ bruit heart only over left lobe of liver that decreases when standing usually identifies this

aortic compression from enlarged liver

- hepatic bruit that does not change with position due to this

Neoplasia

- most common location for peritoneal friction rubs due to capsules rubbing against the peritoneum

spleen or liver

- most common cause of peritoneal friction rub

- heard in LUQ

- also could be splenic abscess or metastatic tumors

Splenic infarction

- RUQ friction rubs are commonly due to this but can be from inflammation (liver abscess/hepatitis)

- can also be from primary tumors (hepatoma)

Metastatic tumors of the liver

- RUQ rub with systolic bruit is this till proven otherwise

neoplasia

- sloshing sound caused by sudden movement

- caused by gas and fluid in an obstructed organ

Succession splash

- cause of common epigastric succession splash (LUQ)

- delays gastric emptying

pyloric channel ulcers

- percussion sound heard over gastric air bubble in the LUQ

tympany

- intestinal ileus or a perforated hollow organ can cause this

generalized tympany

- solid organs, fecal-filled bowel and the flanks in abdominal distention (ascites) have this when percussed

Dullness

- light palpation calls for a depression of the abdominal wall of this distance with the entire palm

1 cm

- intramural masses can be identified on exam by having the patient do this during palpation

- if a mass is more prominent, it's intramural

raise his/her head

- peritoneal irritation can cause this abdominal wall finding

cutaneous hypersensitivity

- RLQ cutaneous hypersensitivity

appendicitis

- cutaneous hypersensitivity over the posterior right lower ribs occurs with same pt's with this

acute cholecystitis (Boas' sign)

- cutaneous hypersensitivity occurring over the left shoulder secondary to diaphragmatic irritation from splenic rupture

Kehr's sign

- can cause severe abdominal pain w/ cutaneous hypersensitivity before a rash appears

Herpes zoster (shingles)

- technique used to do deep palpation

- dominant hand on bottom, flat

two-handed

- key to successfully doing a deep abdominal palpation

- must also assess pt comfortability

- can have pt flex the knees and hips and breath deeply

Pt relaxation

- the muscle tone of the abdominal wall becomes a significant finding if it is rigid (reflex muscle spasm)

- it is classified as these two things

voluntary (guarding) or involuntary

-  willful tensing of the abdominal wall muscles

- can come from fear, anticipation, ticklishness, cold hands, malingering

- usually symmetric

- can be overcome by applying pressure with stethoscope or simultaneously palpating the lower sternum during inspiration

Voluntary rigidity (guarding)

- involuntary rigidity is usually a sign of this

- can be unilateral or bilateral

- does not move with respiration

peritoneal irritation

- pain produced by palpation

- can be direct, indirect, and rebound

tenderness

- caused by localized inflammation of wall, peritoneum or hollow organ

- solid organ may be tender when its capsule is stretched

- tenderness felt just beneath examining hand

Direct Tenderness

- caused by peritoneal irritation from underlying pathology at a location distant to the site of palpation

Indirect tenderness

- transient, sharp, knife-like pain that results when pressure is suddenly released during deep palpation

- develops as a result of peritoneal irritation and inflammation

- can be direct and indirect

Rebound tenderness

- when coughing produces a sharp pain in the abdomen (positive cough test) and rigidity/guarding are present, this pathology is indicated

Peritonitis