Abdominal Tests to Support Diagnosis
Abdominal tests are used to help support you diagnosis. Common bedside assessment tests that can be done to help support your diagnosis are: ascites fluid test, ballot test, McBurney’s point, rebound test, Rosings’s sign, psoas sign, obturator sign, Murphy’s sign and assessment of hernias.
Test for shifting dullness. After mapping the borders of tympany and dullness, ask the patient to turn onto one side. Percuss and mark the borders again. In a person without ascites, the borders between tympany and dullness usually stay relatively constant.
Test for a fluid wave. Ask the patient or an assistant to press the edges of both hands firmly down the midline of the abdomen. This pressure helps to stop the transmission of a wave through fat. While you tap one flank sharply with your fingertips, feel on the opposite flank for an impulse transmitted through the fluid. Unfortunately, this sign is often negative until ascites is obvious, and it is sometimes positive in people without ascites.
IDENTIFYING AN ORAGN OR A MASS IN AN ASCITIC ABDOMEN
To ballotte the organ or mass, straighten and stiffen the fingers of one hand together, place them on the abdominal surface, and make a brief jabbing movement directly toward the anticipated structure. This quick movement often displaces the fluid so that your fingertips can briefly touch the surface of the structure through the abdominal wall.
ASSESSING FOR POSSIBLE APPENDICITIS
The pain of appendicitis classically begins near the umbilicus, then shifts to the right
lower quadrant, where coughing increases it. Elderly patients report this pattern less
frequently than younger ones.
McBurney’s Point. Indicates appendicitis. McBurneys point lies 2 inches from the
anterior superior spinous process of ilium on a line drawn from that process to the
Localized tenderness anywhere in the right lower quadrant, even in the right
flank, may indicate appendicitis. Feel for muscular rigidity. Right-sided rectal
tenderness may be caused by an inflamed adnexa or seminal vesicle, or appendix.
Rovsing’s sign and for referred rebound tenderness. Press deeply and evenly in
the left lower quadrant. Then quickly withdraw your fingers.
Pain in the right lower quadrant during left-sided pressure suggests appendicitis (a
positive Rovsing’s sign). So does right lower quadrant pain on quick withdrawal
Referred rebound tenderness. Right lower quadrant pain on quick withdrawl
Psoas sign. Place your hand just above the patient’s right knee and ask the patient to raise that thigh against your hand. Alternatively, ask the patient to turn onto the left side. Then extend the patient’s right leg at the hip. Flexion of the leg at the hip makes the psoas muscle contract; extension stretches it.
Increased abdominal pain on either maneuver constitutes a positive psoas sign, suggesting irritation of the psoas muscle by an inflamed appendix.
Obturator sign. Flex the patient’s right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. This maneuver stretches the internal obturator muscle. Right hypogastric pain constitutes a positive obturator sign, suggesting irritation of the obturator muscle by an inflamed appendix.
Cutaneous hyperesthesia. At a series of points down the abdominal wall, gently pick up a fold of skin between your thumb and index finger, without pinching it. This maneuver should not normally be painful. Localized pain with this maneuver, in all or part of the right lower quadrant, may accompany appendicitis.
ASSESSING POSSIBLE ACUTE CHOLECYSTITIS
Right upper quadrant pain and tenderness suggest acute cholecystitis.
Murphy’s sign. Hook your left thumb or the fingers of your right hand under the costal margin at the point where the lateral border of the rectus muscle intersects with the costal margin. Alternatively, if the liver is enlarged, hook your thumb or fingers under the liver edge at a comparable point below. Ask the patient to take a deep breath. Watch the patient’s breathing and note the degree of tenderness.
A sharp increase in tenderness with a sudden stop in inspiratory effort constitutes a positive Murphy’s sign of acute cholecystitis. Hepatic tenderness may also increase with this maneuver, but is usually less well localized.
ASSESSING VENTRAL HERNIAS
Ventral hernias are hernias in the abdominal wall exclusive of groin hernias. If you suspect but do not see an umbilical or incisional hernia, ask the patient to raise both head and shoulders off the table. The bulge of a hernia will usually appear with this action
Mass in abdominal wall
Ask the patient either to raise the head and shoulders or to strain down to tighten the abdominal muscles. A mass in the abdominal wall remains palpable. An intraabdominal mass is obscures by muscular contraction.