Get Answer: According Bates Abdominal Question Guide
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According to Bates, the abdominal examination entails proper inspection, auscultation, percussion, and palpation. From the process of the assessment, many issues can be ruled out such as GERD, constipation, diarrhea, diverticulitis, hepatitis, appendicitis, obstruction or a mass. Having a thorough interview questions for the present illness is very important to help narrow the possible cause of a specific area or organs system; question such as abdominal pain, reflux-heartburn like, nausea and vomiting, difficulty swallowing, normalcy of bowel movement all can help with diagnosing the patient. The first thing is inspection of the abdomen. Inspection includes the contour of the abdomen, overall skin color, for example, present of jaundice involves the liver, the movement of the abdomen, the skin temperature, any rashes, dilated veins, or hernia. Next step would include auscultation of all 4 quadrant. The abdomen is divided into 4 quadrant, lower right, upper right, upper left, and lower left to help understand the anatomical placement of the organs. Auscultation for bowel sounds is typically nonspecific but can help the practitioner listen for hypoactive, normoactive, or hyperactive sounds. Also auscultating the aorta, renal and iliac arteries for bruits is important to rule out any abdominal pulsatile mass. Next is percussion, which helps assess for masses that are solid or fluid-filled, or the size of the spleen and liver. When percussing it’s important to listen for distribution of dull or tympany sound. Tympany would preside throughout the abdomen due to gas, and the dull sound would be more distinct for organs such as the liver and spleen or fluid and feces. It is useful technique to percuss to see if there is enlargement in the liver or spleen. One way is to the measure the border of the liver which is about 6-12 cm in the right midclavicular line (Bates, 2021). Start below the umbilicus in the RLQ area of tympany and upward toward the liver, stop once the dullness is heard. Then from the nipple line, percuss downward in the midclavicular line until lung resonance is no longer heard (Bates, 2021). As for the spleen, percuss the left lower anterior chest wall at the sixth rib to the anterior axillary line and down to the costal margin, tympany indicates no sign of splenomegaly. Also, percussion for the bladder is above the symphysis pubis, and bladder volume must be 400 to 600 ml before dullness appears. The last step is palpation which would be performed for all 4 quadrants, both light and deep palpation. Light palpation can help identify tenderness or guarding. And deep palpation can be used to identify any type of masses, sizes, location and whether pulsation is present. Normally the kidney and spleen are not palpable, and it would be an abnormality when they are. One technique for palpating the liver with inspiration is to have the patient to take a deep breath, which will push the liver down to meet the practitioner right fingers. The normal liver edge is soft, distinct in outline, and with a smooth surface (Bates, 2021). As for the spleen, palpation with inspiration, the patient would take a deep breath, and the tip of the spleen comes down to meet your fingertip. Note for any tenderness. Others special test can be done such as the fluid wave test to rule out ascites. Murphy’s sign is helpful in detecting sign of acute cholecystitis. Another example is Rovsing sign which involves rebound tenderness, which the patient will be supine and the practitioner would deeply press in the left lower quadrant and quickly withdraw. If there is pain the right lower quadrant, then it is a sign for appendicitis. Furthermore, CVA tenderness test is percussion over the CVA to rule out pyelonephritis due to inflammation of the renal. In conclusion, there are extensive assessments that can be done for the abdomen to help the practitioner diagnostic a patient. Reference Bickley, L. S. (2021). Bates’ Guide to Physical Examination and History Taking. (13th ed.).Philadelphia: Wolters-Kluwer.
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