SPECIAL ABDOMINAL

. EXAMINATION

I. Assessment of Ascites
A. Inspection
1) globular abdomen w/ bulging
on the flanks
2) everted umbilicus
B. Fluid Wave
1) patient in supine position &
examiner on pt.’s right side
2) place the ulnar edge of another
hand or the patient’s
own hand firmly on the
abdomen in the midline
3) Place your left hand on the
patient’s right flank.
4) With your right hand, reach across the
abdomen and give the left flank a
firm strike/tap.
5) Feel for the impulse of a fluid wave w/
the fingertips of your other hand.

Results (+) : flow will generate a fluid

wave through the abdomen & you
will feel a distinct tap on your
left hand.
Results:
(-) if the border between
tymphanitic and dullness
remain constant

(+) if dullness shifts to the more

dependent side (w/ fluid),
while tymphanitic shift to the
top (gas filled intestines)
D. Puddle Sign
1) Ask the patient to assume a knee-
chest position & maintain for several
minutes to allow fluid to pool by gravity.
2) Diaphragm of stethoscope is applied to
the most dependent part of the
abdomen.
3) The examiner repeatedly flicks the
flank w/ his fingers using constant
intensity.
4) Flicking in the same spot, chest
piece of stethoscope is moved
across abdomen away from
examiner.

Results (+): when the intensity of the

sound becomes louder
when the farther edge of
the puddle is reached.
II. Assessment of Acute
Appendicitis

A. McBurney’s Sign

> (+) direct tenderness at the Right

iliac or McBurney’s point.
B. Blumberg Sign
> (+) rebound tenderness at the
right iliac region

C. Rovsing Sign
> pain felt by the patient in RLQ
w/pressure & release of
pressure on the LLQ.
D. Markle Sign or Jar Tenderness
> pain felt on the RLQ upon jarring
the body either by:
-coughing
-standing on toes then
suddenly drop heels on
the floor
E. Aaron Sign
> pain or distress occurs in the
area of patient’s heart or
stomach on palpation of the
McBurney’s point.
F. Psoas Sign
3 techniques:
1) Ask the patient to lie supine & place
your hand over the lower thigh.
Then raise the leg, flexing at the hip,
while push downward against the leg
2) Position the patient on the left side
& ask that the right leg be raised
from the hip while you press
downward against it.
 3) Ask patient to hyperextend the leg by
drawing it backward while patient
is lying on the right side.

Results (+): patient will experience pain

on RLQ.
Inflamed appendix may cause
irritation of the lateral
iliopsoas muscle.
F. Obturator Sign
1) Patient in supine position flex the right
leg at the hip and knee to 90 degrees
2) Hold the leg just above the knee, grasp
the ankle, and rotate the leg laterally
and medially.

Results (+): pain at RLQ

Inflamed appendix causes
irritation of the obturator
muscle and when stretch it
will cause pain.
III. ASSESMENT ACUTE
CHOLECYSTITIS
A. Murphy Sign
1) Place the fingers of your right hand
under the right costal margin.
2) Ask the patient to take a deep
breath while gliding the
examining fingers upward.
3) Watch the patient’s breathing and
note the degree of tenderness.
Results (+): Inspiratory arrest
secondary to sharp increase in
tenderness as the descending
liver pushes the inflamed GB
onto the examiner’s fingertips.
B. Boa’s Sign
A light touch(hyperesthesia) on the
right costophrenic angle elicit an
exquisite tenderness. This is also
the site of referred pain for
gallbladder.

C. RUQ tenderness