Abdominal examination

Abdominal regions
Abdominal regions
 Abdominal examination

I. Inspection:
 flat/ scaphoid/ distended: fat-fluid-flatus-fetus-
feces-tumor
 Any evident bulge: hernia, suprapubic fullness (full
bladder)..
 Full flanks
 Subcostal angle
 Skin: scars, striae (silver/ purple), dilated
veins(cirrhosis, IVC obstruction), rashes, lesions
 Umbilicus: everted, site, caput medusae, discharge
 Inspection

 Visible pulsations: epigastric (aortic/ Rt ventricular

hypertrophy/ liver)
 Visible peristalsis
 Divercation of the recti
 Superficial palpation

 To identify: tenderness, superficial masses, skin

temperature, rigidity
 Light gentle dipping motion, smoothly in all
quadrants
 If increased resistance: voluntary guarding/ rigidity
- Distract the patient
- Flex the hips
- Try to examine during exhalation
 Deep palpation

 To delineate abdominal masses

 Mass: location, size, shape, consistency, tenderness,
pulsations, movement with respiration
 Liver

 Inspection: swelling, visible pulsations, overlying

skin
 Palpation:
- Lower border: lt/ rt lobes
- Size
- Margin: sharp/ rounded
- Surface: nodular/ smooth
- Tender
- Consistency: soft, firm, hard
- Pulsation
 Liver

 Percussion:
- Upper border: tidal percussion
- Confirm the lower border (false results)
- Liver span in MCL: 6m=5cm
3y= 7cm
10y= 8-10 cm
 Spleen

 If spleen enlarges: anteriorly, downwards and

medially
 Palpation: start in RIF
- size
- edge
- Notch
- Tenderness
- Consistency
- Surface
- pulsation
 Spleen

 Percuss the upper border:

- cannot confirm splenic enlargement, it only raises
suspicion
- Percuss the left lower anterior chest wall: AAL, MAL
 Kidney

 Palpation:
- Normally not palpable
- Left kidney: same way as spleen palpation
- Right kidney: bimanual
- size, mobility, ballottement, tenderness
- Renal angle: fist percussion
 Lt kidney vs. spleen

 Spleen: Palpable notch

edge might extend beyond the midline
percussion is dull
fingers can probe deep to the medial and
lateral borders but not between the mass and the
costal margin
 Kidney: preservation of normal tympany in LUQ
fingers can get between the mass and the
costal margin but not due to its medial and lateral
borders
 Abdomen

 Tests for ascites: -

- start below umbilicus
- Shifting dullness
- Transmitted thrill
 Auscultation:
- Peristalsis: 5- 30/ min
- Friction rub over liver and spleen: liver tumor/
perihepatitis/ splenic infarct
- Venous hum: portal hypertension
- Bruit (arterial: Renal artery stenosis/ liver: Ca)
 Abdomen

 Genitalia
 Groin area
 Anal region
 Appendiceal signs

 Tenderness and rebound tenderness at Mc-burney’s

point
 Rovsing’s sign
 Psoas sign
 Obturator sign