Abdomen :Examination

Abdomen: Examination

A. Inspection

(Supine position, exposed from Nipple to mid-thigh)

1.       Shape and contour of abdomen

·         Normal/Scaphoid/Distended

2.       Umbilicus

·         Position

·         Normally inverted/deeply inverted/flushed/everted

3.       Skin over the abdomen

·         Scar

·         Pigmentation

·         Striae

·         Engorged vein

4.       Movements

·         Respiratory movements- whether all quadrant moving or not

·         Visible peristalsis

·         Pulsatile movements

5.       Any Visible swelling

·         Site and extent

·         Size/Shape/Surface

·         Margin

·         Moving with respiration or not

·         Rising test—whether swelling is parietal or intra-abdominal

6.       Hernial sites

·         Any swelling

·         Any expansile impulse on cough

7.       External genitalia

B. Palpation

Superficial palpation

1.       Temperature/ tenderness

2.       Feel of the abdomen:

·         Soft and elastic feel

·         Muscle guard

·         Rigidity

Deep palpation

1.       Deep tender spots :Any tenderness over the following sites

·         Gastric point: A point in the midepigastrium.

·         Duodenal point: A point in the transpyloric plane 2.5 cm to the right of midline

·         Mcburney’s point: A point in the right spinoumbilical line at the junction of medial two-thirds and lateral one-third.

·         Amebic point: Point on left spinoumbilical line corresponding to Mcburney’s point on right side

·         Renal point: A point at the junction of lateral border of erector spinae and the 12th rib

2.       Murphy’s sign:

·         Found positive in patient with acute cholecystitis

·         At the height of inspiration àinflamed gallbladder impinges on the thumbàcatch in breath and patient will wince with pain

3.       Palpation of organs:

·         Liver

·         Spleen

·         Kidneys

·         Gallbladder if enlarged

4.       Palpation of any other lump:

·         Position and extent in relation to abdominal quadrants

·         Shape/Size/Surface/Margin

·         Consistency

·         Mobility: with respiration

·         Mobility from side to side, up and down

·         Fixity to skin or underlying structure

·         Rising test (Carnett’s test) to confirm intra-abdominal or parietal swelling

·         Knee elbow position and examine the swelling again to decide whether swelling is intraperitoneal or retroperitoneal(usually avoided)

5.       Hernial sites

6.       External genitalia

C. Percussion

1.       Shifting dullness

2.       Fluid thrill

3.       Succusion splash over stomach (In GOO)

4.       Upper border of liver dullness

5.       Upper border of splenic dullness

6.       Percussion over abdominal lump

D. Auscultation

1.       Peristaltic sound( Bowel sound)

·         Normal

·         Increased (Obstruction)

·         Absent (Peritonitis)

2.       bruit

3.       Venous hum

E. Ausculto-Percussion

·         In case of gastric outlet obstruction to delineate the greater curvature of the stomach.

Never forget to examine (Norman Browse)

§  Supraclavicular lymph glands

§  Hernia orifices

§  Femoral pulses

§  Genitalia

§  Bowel sounds

§  Anal canal and rectum