Four quadrant System - formed by 2 imaginary lines drawn:

- Vertically- from tip of the sternum to the symphysis pubis passing thru the umbilicus
- Horizontally- from side to side passing thru the umbilicus

Nine Regions (9) or sections - formed by :

- 2 imaginary and parallel horizontal lines
o Crossing the lowest border of the costal margins and the ASIS
- 2 imaginary and parallel vertical lines
o Right and left midclavicular lines along the lateral borders of the rectus abdominis
muscles to the inguinal areas

Preparation of the Patient to the Abdominal Examination

Find a good source of lighting, and if necessary, penlights could also be used to illuminate the abdomen.
Make sure that the patient is relaxed and well draped and if anxious, distract the patient by talking to
him. The abdomen should also be expose from just above the xiphoid process to the symphysis pubis
having visible groin, draped genitalia, and relaxed abdomen. So to proceed, the examiner should stand
at the patient’s right side and perform the IAPP in an orderly manner.

AUSCULTATION
Auscultation of the abdomen should proceed before the palpation, otherwise, the stimulation of the
bowels might cause a false increase in peristalsis

The presence of bruits could indicate a vascular occlusive disease, but an estimated 4-20% of healthy
individual have abdominal bruits

PERCUSSION
Tympanic- air filled
Dull Sounds- solid structure or fluid filled and a presence of ascites

Single Handed Technique

Double Handed Technique
- Obesity
- Increased Muscle Tone
- Target organ is deep