This document provides guidance on performing an abdominal examination. It outlines important components of history to obtain including symptoms like dyspepsia, dysphagia, and altered bowel habits. The examination involves inspecting the abdomen and specific regions, palpating the abdomen and organs like the liver and spleen, performing percussion, and auscultating bowel sounds. Specific techniques for examining each organ are described along with signs to note. The full examination is supported by additional tests as needed.

1. Abdomen
History & Examination

2. Important history
 Dyspepsia- heartburn
 Dysphagia- difficulty swallowing
 Altered bowel habit- diarrhea/constipation
 Pain- colicky, stretch, radiation, referred
 Bleeding- UGI/LGI
 Jaundice
 Urinary symptoms- hematuria, dysuria, frequency,
urgency, hesitancy, retention
 Appetite
 Dietary history

3. Examination
 Oral cavity
 Abdomen
 Male genitalia
 Anus/rectum

4. Oral cavity
 Angular stomatitis, cheilitis
 Teeth- number, color, ridges, caries
 Gums- swelling, bleeding, pyorrhea
 Buccal mucosa- ulcer, pigmentation
 Tongue- size, color, papillae
 Palate, tonsils, pharynx

5. Abdomen- regions
 4-
vertical & horizontal planes thru umbilicus-
RUQ, RLQ, LUQ, LLQ
 9-
vertical planes thru 9th
costal cartilage & femoral
artery; horizontal planes are subcostal &
interiliac- R & L
hypochondrium, lumbar, iliac and
epigastrium, umbilical, hypogastrium

6. Abdomen- regions

7. Quadrants & organs
 RUQ- liver, GB, upper pole of R kidney,
hepatic flexure of colon
 LUQ- stomach, spleen, pancreas, upper
pole of L kidney, splenic flexure of colon
 RLQ- lower pole of R kidney, appendix,
terminal ileum, R colon, R ovary
 LLQ- lower pole L kidney, L colon,
L ovary

8. Pre-examination
 Comfortable room & couch
 Adequate light
 Patient lying supine
 Adequate exposure
 Examiner’s hand at the level of patient’s
abdomen

9. Examination- components
 Inspection- see, don’t touch
 Palpation- touch
 Percussion- tap
 Auscultation- use stethoscope

10. Inspection
 Shape- scaphoid, normal, distended
 Umbilicus- shape, inverted/everted
 Movements- normal or restricted,
pulsation, visible peristalsis
 Striae or scars
 Prominent veins
 Genitalia & groin

11. Palpation
 Relaxed patient & abdominal wall
 Start from the point farthest from
possible area of involvement
e.g. for liver start from LLQ
& for spleen from RLQ
 Palpate whole abdomen in an order

12. Special techniques
 Deep palpation- in obese, muscular or
poorly relaxed
 Dipping- tense ascites
 Bimanual- for kidney & spleen
 Ballotable- kidney
 Shifting dullness & fluid thrill- for ascitis

13. It helps
 Spleen
 L hypochondrium
 Grows towards RLQ
 Upper border not
reached
 Moves with respiration
 Medial notch
 Not ballotable
 Dull on percussion
 L kidney
 Renal angle posteriorly
 Grows towards LLQ
 Upper border reachable
 Restricted mobility
 No notch
 Ballotable
 Colon overlying on
percussion

14. Liver
 RUQ
 Moves with respiration
 Tender or not?
 Edge- soft, firm, hard
 Surface- smooth, nodular
 Pulsatile in TR
 Confirm span by percussion

15. Gall bladder
 Underlies liver in RUQ
 Moves with respiration
 Usually not palpable
 Tender- Murphy’s sign- +ve in acute
cholecystitis
 Palpable GB- mucocoele, cancer,
CBD obstruction

16. Urinary bladder
 Midline, suprapubic
 Usually not palpable
 When palpable- smooth, symmetrical,
lower border not reached,
 Urge to micturate on palpation
 Dull on percussion

17. Percussion
 Only light percussion required
 Resonant note allover, except over liver
where it is dull
 Used to confirm liver or spleen or
bladder enlargement & ascitis

18. Auscultation
 Paraumbilical
 For bowel sounds or bruit
 Normal BS- intermittent gurgles
interspersed with tinkles
 Increased- intestinal obstruction
 Decreased- paralytic ileus
 Bruit- over aorta, iliac/renal arteries

19. Don’t forget
 Groin- LNE, hernia
 Male genitalia
 PR examination- for local pathology,
prostate examination in males

20. Stigmata of CLD
 Muscle wasting
 Pallor, jaundice
 Clubbing
 Palmar erythema
 Dupuytren’s contracture
 Spider nevi
 Gynecomastia
 Testicular atrophy
 Caput medusae
 Ascites

21. Supported by
X-ray, US/CT, Endoscopy