What are the abdominal physical assessment tests?

From the Guidelines

Abdominal physical assessment is crucial in evaluating patients with potential abdominal issues, and it should include a combination of inspection, auscultation, percussion, and palpation to identify signs of underlying conditions such as appendicitis, cholecystitis, bowel obstruction, peritonitis, and masses. The assessment should begin with inspection, observing the abdomen for distention, asymmetry, visible masses, or pulsations. Auscultation should follow, listening with a stethoscope for bowel sounds in all four quadrants for 2-5 minutes, noting their frequency and character 1. Percussion involves tapping the abdomen to detect fluid, masses, or organ enlargement, with dullness suggesting solid organs or fluid while tympany indicates gas. Palpation, both light and deep, helps identify tenderness, masses, or organomegaly. Specific tests include Murphy's sign (right upper quadrant pain with inspiration during palpation, suggesting gallbladder inflammation), McBurney's point tenderness (indicating possible appendicitis), rebound tenderness (pain when pressure is suddenly released, suggesting peritoneal inflammation), and psoas sign (pain with hip extension, suggesting retroperitoneal inflammation) 1.

The physical examination is often difficult due to the presence of abdominal distension, which is the result of colonic obstruction of several days duration; if there are no signs of peritoneal irritation, as is often the case, this may result in a delay in diagnosis 1. Nonetheless, the absence of peritonitis does not indicate the absence of bowel ischemia. Asymmetric gaseous abdominal distention associated with emptiness of the left iliac fossa is pathognomonic for sigmoid volvulus, though this can be very challenging to detect 1.

In many countries worldwide, a large proportion of patients with diffuse peritonitis still present to the hospital with unacceptable delay, reducing the percentage of surviving at the lowest rates in the world 1. In emergency departments of limited-resource hospitals, the diagnosis of intra-abdominal infections is mainly clinical; supported by basic laboratory tests like full blood count (complete blood count) 1. Ultrasonography is sometimes done to aid diagnosis, if available. Therefore, the clinician has to improve clinical diagnosis by looking carefully for those signs and symptoms.

Some key points to consider during abdominal physical assessment include:

• Severe abdominal pain out of proportion to physical examination findings should be assumed to be acute mesenteric ischemia until disproven 1
• Abdominal distension, diminished bowel sounds, and often an empty rectum on digital examination are classic signs of sigmoid volvulus 1
• The absence of peritonitis does not indicate the absence of bowel ischemia 1
• Asymmetric gaseous abdominal distention associated with emptiness of the left iliac fossa is pathognomonic for sigmoid volvulus 1
• A step-up approach for diagnosis from clinical and laboratory examination, to imaging examination should be used and tailored to the hospital's resources 1

From the Research

Abdominal Physical Assessment Tests

The abdominal physical assessment is a crucial diagnostic tool in evaluating the overall health of a patient and identifying acute pathology 2. The examination has the potential to minimize further testing or radiation and serves as a key diagnostic tool.

• The physical examination of the abdomen includes several components, each of which can provide valuable information about the patient's condition 2.
• A thorough abdominal examination can help guide the workup and diagnosis of acute abdominal pain, which has a broad differential diagnosis 3.
• The examination findings, along with the patient's history and pain location, can help identify the underlying cause of abdominal pain and determine the need for further testing or imaging 3.

Components of the Abdominal Examination

The abdominal examination includes several components, including:

• Inspection: visual examination of the abdomen for any abnormalities or signs of disease 2.
• Auscultation: listening to the sounds of the abdomen using a stethoscope 2.
• Palpation: feeling the abdomen with the hands to detect any tenderness, masses, or other abnormalities 2.
• Percussion: tapping on the abdomen to detect any abnormalities in the underlying organs 2.

Diagnostic Value of the Abdominal Examination

The abdominal examination can be diagnostic for certain conditions, such as:

• Urolithiasis: the examination may reveal tenderness or a palpable mass in the flank or abdomen 3.
• Diverticulitis: the examination may reveal tenderness or a palpable mass in the lower abdomen 3.
• Cholecystitis: the examination may reveal tenderness or a palpable mass in the right upper quadrant of the abdomen 3.
• Appendicitis: the examination may reveal tenderness or a palpable mass in the lower abdomen, particularly in the right lower quadrant 3.