this is the first chapter of abdominal examination

1. Abdominal Clinical
Examination (Ep. I)
PROF. DR. MOHAMED-NAGUIB WIFI
PROFESSOR OF MEDICINE AND
HAPATOGASTROENTEROLOGY
CAIRO UNIVERSITY

2. Any Local Examination
•Inspection
•Palpation
•Percussion
•Auscultation

3. Abdominal
Examination
(Inspection)

4. INSPECTION
• Examine under good light and warm surroundings.
• Supine position.
• Head supported by pillow.
• Arms at side (behind head tightens abdomen) & legs
straight, Bending knees may relax abdomen
• Expose abdomen from Nipple To Knees inguinal (and
genital areas are covered until they are to be examined)
• Practically from xiphisternum to pubic symphysis.

8. Inspection of the Back
•Swelling
•Deformity
•Loin masses
•Pigmentation
•Tuft of hair
‫بنقوله‬ ‫ليه‬
‫األول؟؟‬

9. SHAPE
• Normal: FLAT or slightly SCAPHOID, symmetrical .
• Abnormal  DISTENSION (generalized Vs. localized)
• Generalized (5F’s)
• Fat
• Fluid
• Flatus
• Faeces
• Fetus

11. Localized
Symmetrical Asymmetrical
Small Bowel
Obstruction
- Organomegaly
- Liver
- Spleen
- Ovarian
- Mass
- Hernias

12. Movements
•Normal  rise on inspiration and fall
on expiration
•Free and equal on both sides
•Abnormal 
•Absent/diminished- generalized
peritonitis (still/silent abdomen).

14. Subcostal Angle

15. Visible Pulsation
•Noticed in Epigastrium  confirm with palpation
•Nervous and thin patients

16. Causes of Epigastric Pulsations

17. “Divarication Of Recti”

18. Umbilicus

21. Suprapubic Hair Distribution

22. Hernial Orifices

23. Skin and surface
• Striae – white/ pink
wrinkled linear marks
• Striae gravidarum or
atrophica seen in
• Pregnancy
• Ascites
• Wasting disease
• Severe dieting

24. petechiae
echymosis

25. Scars
• Red and Pink- recent
• White –old scars

27. Visible peristalsis
• Normal in elderly - lax
abdominal muscles
• Obstruction at pylorus
• Obstruction in small or
large bowel

28. Superficial veins
• Visible in Distension
• Visible & Dilated in Obstruction of
• SVC
• IVC
• Portal vein
• Superficial abdominal veins are dilated- to provide
collateral circulation.
• These veins represent opening up of anastomosis
between portal and systemic veins.

34. Pigmentation
Linea Nigra Erythema ab igne Seborrhoeic warts
campbell de
morgan spots hemangioma
striae