bims
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hello people.i saw in usmle world for cs that u should auscultate the abdomen and percuss before you palpate.is this really true?i thought all examination was IPPA(inspection,palpation,percussion auscultation)in that order?thanks in advance.
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| alice8
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Abdomen examination is exception, in order to not activate bowel sounds, or not to make a change you would better make the auscultation first...
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| retroviridae
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This must be a US thing. I never heard about this before, but as I read Kaplan's book, I too auscultated before I percussed. I think you have to percuss pretty hard to stimulate bowel sounds!
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| bims
Forum Senior
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thanks everyone.point noted and taken.so is the correct order for abd inspection,auscultation,palpaltion then percussion or does percussion come before palpation(saw this in usmle world too)?
one more question after percussing the four quadrants for tympanitic sounds,do you still have to do shifting dullness for ascites or is that enough to detect ascites?
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| retroviridae
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AS you know, what you have described would only detect frank gross ascites. These are normal people on the exam, so if you suspect it might be there, I would say you have to do shifting dullness. Puddle's sign would probably be better and faster, but I bet they don't know what that is so wouldn't be able to check you off for that. Don't know about auscultating before palpating. Probably is correct since it follows the logic of percussing leading to increased BS. I think that's all nonsense though.
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| alice8
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Hi Retroviridae,
It is not 'US thing', I think it is global and same everywhere, at least we have the same procedure and process in my country as well...You are right maybe with the percussion it is hard to stimulate bowels but with the massage of palpation it is more than possible I think...
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| retroviridae
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It's not an Indian thing, that's for sure. Makes me wonder if other countries which follow the British system do it that way too.
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