Key Concepts 
Abdomen

Blumberg’s Sign (rebound tenderness)
•	use when pt tells you there is tenderness or if tender during tenderness
•	hold hand at 90 degree angle (perpendicular to abdomen) push down slowly and deeply, then lift quickly
•	perform this test at the end of assessment because it can cause  pain and muscle rigidity 
•	pain on release confirms rebound tenderness
•	reliable test for peritoneal inflammation which is associated with appendicitis 

Murphy’s Sign (inspiratory arrest)
•	normally, palpation of liver is painless
•	pain occurs in a person with inflamed gallbladder (choleystits)
•	Hold finger under liver boarder ask patient to take deep breath want it to painless 
•	Painless =  normal

Iliopsoas test 
•	Inflamed iliopsoas, pain is felt in the RLQ
•	Inflammation of the iliopsoas can occur with perforated appendix   
•	“Perform when acute abdominal pain of appendicitis is suspected” 
•	Supine lift leg, flexing at hip then push down and have them try to resist 
•	Negative = no difference felt 
Obturator test
•	Another test that stretches the obturator muscle but does  NOT work to diagnose 
Appendicitis

RUQ						LUQ
Gallbladder					Stomach			
Liver						Spleen
Duodenum					Left lobe of Liver
head of pancreas				Body of pancreas
right kidney and adrenal 			Left Kidney and adrenal
hepatic flexure of colon			Splenic flexure of colon
part of ascending and 				Part of the transverse and
                   transverse colon				        descending colon

RLQ						LLQ
	Cecum						Part of descending colon
	Appendix					Sigmoid colon
	Right ovary and tube				Left ovary and tube
	Right ureter					Left ureter
	Right spermatic cord				Left spermatic cord

Borbrymi- Stomach growl

Ascites (p 557) Free fluid in the peritoneal cavity 
•	everted umbilicus, bulging flanks when supine, taut, glistening skin; recent weight gain, increase in abdominal girth
•	normal bowel sounds over intestines but diminished over ascetic fluid
•	tympany where instenies float, dull over fluid
•	produces fluid wave and shifting dullness
Ascites occurs with heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, and cancer

Hepatomegaly- enlarged liver

Slpenomegaly- enlarged spleen 

Hernia-  Occurs when part of an internal organ bulges through a weak area of muscle

Hernia types (p 560)  umbilical, epigastric, incisional, and diastasis recti

Absent bowel sounds-
•	must listen for a full five 
•	absent sounds are rare 
•	hypoactive or absent may occur after abdominal surgery or inflammation 
and pneumonia

Hyperactive sounds- loud, high pitched, rushing and occur frequently 

Hypoactive sounds- not very active

CVA tenderness (costovertebral angle tenderness) 
•	use fist percussion
•	used to access the kidney 
•	want patient to feel no pain
•	 pain indicates inflammation of the kidney or paranephric area 
•	Pain is sharp