The abdominal examination consists of four basic components: inspection, palpation, percussion, and auscultation. It is important to begin with the general examination of the abdomen with the patient in a completely supine position. The presence of any of the following signs may indicate specific disorders.

1. Examination
of abdomen
PRESENTED BY:
HAFIZA AIMAN HUMAIRA
P R E S E N T A T I O N
Examination
of Abdomen

2. Conventionally the abdomen is divided
into 9 regions
There are 4 dividing lines:
• midclavicular (2) - vertical
• subcostal - upper horizontal
• Trans-tubercular – lower horizontal
Abdominal regions

4. Organs by Quadrants

5. BEFORE EXAMINATION
• Introduction
• Explain the procedure
• Gain permission to proceed
• Arms at side or crossed over chest
• Ask the patient to point to any painful
areas; examine last
• Warm hands and stethoscope

8. • Inspection
• Palpation
• Percussion
• Auscultatio
n
light and deep palpation, palpation of liver
edge, spleen tip, kidneys, and aorta, percussion
includes percussion of liver span.
Abdominal examination

9. INSPECTION
• Shape and Distension
• Umbilicus
• Scars
• Movements
• Prominent veins
• Striae
• Bruises
• Pigmentation
• Visible peristalsis
Standing at the foot of the table
Lower yourself until the anterior abdominal wall
ask the patient to breathe
normally while you are inspect
the abdomen.

12. ABDOMINAL
PULSATION
• Aortic pulsation- visible in
nervous, anemia.
• Transmitted pulsation- any mass
lying over major artery produce
pulsation.
• Rt ventricular pulsation seen in
epigastric region
DILATED
VEIN

15. Assessing muscle tone with superficial
palpation
• Gentle pressure applied to the abdominal wall should allow the
examiner to depress the anterior wall of the abdomen as the
muscles relax
• Contraction of the muscles underlying the hand as pressure is
applied is called “guarding” and may indicate some underlying
inflammation
• A rigid abdominal wall, resisting any attempt to push back the
abdominal wall and usually not moving with respiration, indicates
underlying peritoneal inflammation and is called “rigidity”
• A marked, acute exacerbation of pain on sudden release of
pressure applied to the abdominal wall is called “rebound”

16. Deep palpation
1999 - 2010
Development
• Deep
⚬ Using firm pressure to
assess for deep
swellings/abnormalities
• Deep palpation must be done
with the palmar aspect of the
fingers (get on the same level
as the abdomen)

17. Methods of Palpation
• Classical method
(single-handed
palpation)
• Two-handed method
• Bimanual examination
• Dipping method

19. • When palpating organs or masses feel for the edges
• Palpation of masses or organs may be assisted by assessment
of mobility in relation to respiration
• liver descends towards right iliac fossa on
• inspiration
• spleen descend inferio-medially on inspiration towards the
right iliac fossa
• the kidneys descend on inspiration
Palpatio
n

20. The liver moves inferiorly on
inspiration
Enlargement of the liver also
occurs in an inferior direction
• In view of the direction of enlargement, palpation
for the liver should commence well away from the
costal margin in the right iliac area
• The thumb is extended to expose the lateral
margin of the index finger
• The hand is positioned so that the lateral margin
of the index finger is parallel with the costal
margin
How liver is
palpated

22. the examiner's right hand is
initially placed on the
patient's abdomen in the right
lower quadrant and parallel to
the rectus muscle in the MCL.
- Gently pressing in and up,
ask the patient to take a deep
breath
Single-handed
method
Another method of palpating the liver uses the
radial border of the index finger. In this method
the anterior hand is placed flat on the anterior
abdominal wall with fingers parallel to the costal
margin

23. • The long axis of the spleen lies
along the the line of the 10th rib
• The spleen moves inferio-
medially on inspiration
• Even on deep inspiration the
normal spleen cannot be felt on
palpation
• To be palpable the spleen must
enlarge to at least twice normal
size
• The patient is asked to take a deep breath in and pressure applied by the examiners hand
to the abdominal wall
• If the spleen is not palpated, the examining hand is moved closer to the costal margin by
about 1-2 cm
Palpation of the
spleen

24. • They are retroperitoneal organs
and deep bimanual palpation is
required.
• To examine position the patient
close to the edge of the bed
• Tuck the palmar surfaces of one
hand into the patients flank
• Nestle the finger tips in the renal
angle
Palpation of the kidneys

28. Percussion
• Dull sounds: solid or fluid-filled structures
• Resonant sounds: structures containing air or
gas
• It is important to distinguish kidney
enlargement from splenomegaly on the left and
hepatomegaly on the right
⚬ Percussion of an enlarged liver or spleen will
be dull whereas over the kidney it should be
resonant due to the overlying bowel
⚬ The kidneys can be “balloted” this a
technique where by a structure that is not
fixed can be patted between the examining
fingers

29. • General abdomen - should be
resonant
• Organs
⚬ Liver - dull
⚬ Spleen - dull
⚬ Kidneys - resonant
⚬ Bladder - dull
• Ascites
⚬ Shifting dullness
⚬ Dullness peripheral
• Ovary Dullness central
Percussion

30. • Determines cause of abdominal distension,
distinguishes between fluid and gas.
• There has to be a lot of fluid (ascites) present
which can flow freely for the method to work
• With the patient lying on their back the highest
point of fluid is detected by percussion and
marked
• The patient rolls to an angle and is allowed to
rest in this position for a short time to allow the
free fluid to flow and establish a new upper level
• Percussion is repeated and fluid confirmed by
detecting
dullness “above” the previous level
Detecting shifting dullness

31. FLUID THRILL
• Place the palm of your left hand
against the left side of the abdomen
• Flick a finger against the right side
of the abdomen
• Ask the patient to put the edge of a
hand on the midline of the
abdomen
• If a ripple is felt upon flicking we call
it a fluid thrill = ascites

34. Thank
You.
For Your Attention
OTHER EXAMINATION
• EXAMINATION OF GROIN
• HERNIA AND GENITALIA
• PER RECTAL EXAMINATION
INSPECTION
PALPATION