This document provides guidance on inspecting the abdomen during a clinical examination. It describes examining the abdomen in good light with the patient in a supine position and exposed from the nipples to knees. Key aspects to observe include the shape, movements, pulsations, scars, skin changes, hernial openings, and visible peristalsis or veins. Abnormal findings may indicate conditions like distension, organomegaly, obstruction, or skin changes. A thorough abdominal inspection is an important first step in the clinical examination process.

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