From the Guidelines
A thorough abdominal examination involves several sequential steps, including inspection, auscultation, percussion, and palpation, to assess for distension, tenderness, and other abnormalities, as outlined in the ECCO statement 3D, which emphasizes the importance of physical examination in patients with ulcerative colitis 1. When performing an abdominal examination, it is essential to start with inspection, observing the abdomen for distention, visible masses, scars, skin changes, and abnormal movements.
- The next step is auscultation, listening with a stethoscope for bowel sounds in all four quadrants and for bruits over major arteries.
- Percussion follows, tapping the abdomen to assess for tympany, dullness, and to determine liver and spleen size.
- The final step is palpation, first light and then deep, systematically examining all four quadrants for tenderness, masses, organomegaly, and abnormal findings, as patients with severe disease may exhibit abdominal tenderness and distension 1. It is crucial to begin with non-tender areas and progress to areas of reported pain, maintaining patient comfort throughout the examination by explaining each step and ensuring proper positioning, usually supine with knees slightly flexed 1.
- Special maneuvers may include checking for rebound tenderness, Murphy's sign for gallbladder inflammation, and assessing for ascites with fluid wave or shifting dullness tests.
- Throughout the examination, observing facial expressions for signs of discomfort is vital, as physical examination findings depend on the extent and severity of disease 1.
From the Research
Steps Involved in a Thorough Abdominal Examination
- The location of pain is a useful starting point and will guide further evaluation, as certain conditions are more likely to occur in specific areas of the abdomen 2
- A thorough medical history is essential, including questions about bowel movements, vomiting, and any previous abdominal symptoms or surgeries 3
- Physical examination techniques, such as palpation and auscultation, are used to assess the abdomen for tenderness, distension, and bowel sounds 3, 4
- Laboratory tests and imaging studies, such as ultrasonography and computed tomography, may be ordered to confirm a diagnosis or rule out other conditions 2, 5
- Special populations, such as women and the elderly, may require a different diagnostic approach due to the possibility of atypical symptoms or underlying conditions 2, 5
Techniques Used in Abdominal Examination
- Palpation is a technique used to detect abdominal tenderness and express pain through touch 4
- Auscultation is used to listen to bowel sounds and assess for any abnormalities 3
- Ultrasonography and computed tomography are imaging techniques used to visualize the abdominal organs and diagnose conditions such as appendicitis or bowel obstruction 2, 5
- Pressure pain threshold (PPT) measurements can be used to assess abdominal tenderness and diagnose conditions such as functional dyspepsia 6
Considerations for Special Populations
- Women are at risk of genitourinary disease, which may cause abdominal pain, and require a thorough pelvic examination as part of the abdominal examination 2
- The elderly may present with atypical symptoms of a disease and require a more comprehensive diagnostic approach 2, 5
- Pediatric patients may require a different diagnostic approach due to the possibility of conditions such as appendicitis or adenomesenteritis 5