ABDOMINAL EXAMINATION

Before examining:
• Postion: Ask the patient to keep the arms at
the sides or folded across the chest. When
the arms are above the head, the abdominal
wall stretches and tightens, making palpation
difficult.
• Exposure: From the nipple line to midthigh
but for the patients dignity drape to the level
of the symphysis pubis.
• Before you begin palpation, ask the patient to
point to any areas of pain so that you can
examine these areas last.
• Approach the patient calmly and avoid quick,
unexpected movements. Watch the patient‘s
face for any signs of pain or discomfort. Avoid
having long fingernails when examining the
patient.
 Inspection
You can stand either on the right side or on the side of his/her
leg.

Inspect for:
The contour of the abdomen: Flat, Rounded, Protuberant, (DDx.
Ascites, Mass) ,Scaphoid (markedly concave or hollowed)

Flanks: full, bulged (Ascites), convex. Symmetry (Asymmetry

suggests an enlarged organ or mass)
• Are there visible organs or masses? Look for an enlarged liver
or spleen that has descended below the rib cage.
 Inspection
The skin
Scars
Striae; Old silver striae or stretch marks are normal.
Dilated vein: Can be from ;
- Portal hypertension : flow of blood is away from
Umbilicus- Can be:- Inverted( normal)Everted,Central,
Deviated ,Slit
• - Horizontal slit (DDx. Ascites)
• - Vertical slit (DDx. ovarian tumor)
 Inspection
Pulsations: (DDx. aortic aneurysm or of
increased pulse pressure)
Hernia: see the following areas by asking the
patient to strain/cough
- Epigastric
- Umbilical
- Inguinal
- Femoral
 Palpation

Don’t forget: - To ask for any place where they

feel pain and to look at your patients face.

Superficial palpation
• Superficial tenderness
• Superficial mass
 Palpation
Deep palpation

• Liver: search for palpable liver, starting from

right iliac fossa upward.
• Spleen: search for palpable spleen starting
from right iliac fossa obliquely along the
umbilicus.
• Kidney: Bimanual palpation
 Palpation
Differentiation of spleen from kidney, usually during enlargement

Spleen Kidney
Has Splenic notch on medial Has no notch
border

Grow oblique and medially --Moves with Not move with respiration
respiration

You can‘t insert your finger You can insert

bellow costal margin

Bimanually not palpable Bimanually palpable

 Percussion
Abdomen :
• Tympanic ; indicate underlying gas
• Dullness ; DDx. ( fluid, tumor )
• Liver: total liver span (8-12 cm for male) and
(6-10 cm for Female)
 Percussion
• Shifting dullness; is a change in the location of
dullness to percussion when the patient is turned
is positive for accumulation of fluid >1500 ml
• Fluid trill

Either Positive shifting dullness or fluid thrill

indicates the presence of fluid in the abdominal
cavity and we call this accumulation of fluid as,
Ascites.
 Auscultation

Listen to the abdomen before performing percussion or palpation

because these maneuvers may alter the frequency of bowel
sounds.

• Place diaphragm of your stethoscope in the right lower

quadrant, because of the presence of iliocecal valve, which will
accentuate the sound.
Bowel sound ( 5 to 34 per minute Normoactive), you hear gurgles
- Hypoactive < 5 per minute
- Hyperactive >35 per minute , you may hear
borborygmi
 Auscultation
Bruits:
• Aortic (ddx. Aortic aneurysm)
• Renal (ddx. Renal artery stenosis)
• Iliac
• Femoral
• Liver (ddx Tumors ; resulting in increased
vascularity)
• Spleen
 Auscultation
Friction rubs:
• Liver ( DDx. hepatoma, gonococcal infection
around the liver)
• Spleen (DDx. splenic infarction)