Special manoeuvres for abdominal assessment

If your patient is presenting with abdominal pain, discomfort or bloating, it’s important to determine what may be causing it. When looking to carry out an examination, there are a few special manoeuvres that can help rule in/out certain conditions. Here we take a closer look.

Rebound tenderness

Use your fingertips to slowly press over the abdomen. Once any pain or discomfort has subsided, quickly remove your fingers to release the pressure. If there is pain during rebound, it could be a sign of peritoneal inflammation.

Heel strike

Ask the patient to stand up with their legs straight, then raise up on their toes. Then get them to relax so that their heel strikes the floor. This will jar the body, and if abdominal pain is present at that point, it could be indicative of peritoneal irritation and/or appendicitis. As an alternative, you could ask the patient to lay facing upwards on the examination table while you use your fist to strike the underside of their feet. If the patient complains of abdominal pain, they are said to have a positive heel strike test.

Rovsing’s sign

Press deeply into the right lower quadrant of the patient’s abdomen, then quickly release the pressure. If there is pain in the left lower side, appendicitis should be considered.

Psoas sign

Place your hand on the patient’s thigh just above the knee, and ask them to raise their thigh against your hand. This serves to contract the psoas muscle, producing abdominal pain if the patient’s appendix is indeed inflamed.

Obturator sign

This is where pain occurs with the passive inward rotation of the hip with the knee bent (so that the obturator internus muscle is stretched). Again, the pain could be a sign of appendicitis. You should carry out this manoeuvre with both legs, one at a time.

Murphy’s sign

Position your fingers at the bottom of the rib cage at the tip of the liver, and ask the patient to breathe in deeply. This will cause the patient’s gall bladder to rise up just below your fingers and will be painful if inflamed. This may be indicative of cholecystitis.

Hepatojugular reflux

Press down on the abdomen in the mid-epigastric region and ask the patient to breathe normally. Look out for jugular venous pressure (JVP) in the next when the pressure is applied, and also the sudden drop of the JVP when you remove your hand. This is exaggerated when the patient has right heart failure.

Can you confidently determine the causes behind abdominal pain?

Patients may be experiencing abdominal pain for a huge range of reasons and the cause can be hard to ascertain. Usually it’s something minor, but abdominal pain must be taken seriously and diagnosed effectively in order to bring about the best outcomes, particularly if it points to something more serious. At PDUK we offer two particularly useful CPD courses covering this topic.

The first one is our face-to-face Five-day patient assessment skills workshop. Aimed specifically at nurses, non-medical prescribers, pharmacists, paramedics, medical students and other allied health professionals, it acts as a springboard for diagnostic proficiency and clinical decision making. After studying basic history taking and physical examination techniques, you will have the opportunity to perform a complete physical examination reflecting clinical practice. The course mainly focuses on the adult patient and is designed to build all-round confidence. It’s very thorough and detailed, lasting 5 days and worth 35 hours of CPD.

Then there’s our Five Day Patient Assessment Workshop Online. Highly interactive, it focuses on core history taking and physical examination with plenty of hands-on practice. It also offers practitioners a firm foundation to develop competence in clinical decision making and safe patient management.

Held entirely online, the course is perfect for remote learning and is also worth 35 hours of CPD over 5 days.

As both of these courses cover a wide range of topics and disciplines, they tend to get booked up early. So if you’re interested in joining us, get signed up now!