You’re performing an abdominal assessment on Brent who is 52 y.o. In which order do you proceed?
A. Observation, percussion, palpation, auscultation
B. Observation, auscultation, percussion, palpation
C. Percussion, palpation, auscultation, observation
D. Palpation, percussion, observation, auscultation
Correct Answer: B. Observation, auscultation, percussion, palpation
Begin with the general inspection of the patient and then proceed to the abdominal area. This should be performed at the foot end of the bed. The general inspection can give multiple clues regarding the diagnosis of the patient, for example, yellowish discoloration of the skin (jaundice) indicates a possible hepatic abnormality.
Option A: A proper technique of percussion is necessary to gain maximum information regarding abdominal pathology. While percussing, it is important to appreciate tympany over air-filled structures such as the stomach and dullness to percussion which may be present due to an underlying mass or organomegaly (for example, hepatomegaly or splenomegaly).
Option C: Auscultation is done before palpation to avoid stimulating peristaltic movements and distorting auscultatory sounds. The diaphragm of the stethoscope should be placed on the right side of the umbilicus to listen to the bowel sounds, and their rate should be calculated after listening for at least two minutes. Normal bowel sounds are low-pitched and gurgling, and the rate is normally 2-5/min.
Option D: There are three stages of palpation that include superficial or light palpation, deep palpation, and organ palpation and should be performed in the same order. Maneuvers specific to certain diseases are also a part of abdominal palpation. The examiner should begin with superficial or light palpation from the area furthest from the point of maximal pain and move systematically through the nine regions of the abdomen.
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