How do I perform an abdominal physical examination?

From the Guidelines

To perform a physical examination of the abdomen, begin by ensuring patient comfort in a supine position with exposed abdomen from xiphoid process to pubic symphysis, and then proceed with inspection, auscultation, percussion, and palpation to assess for signs of disease or injury, as recommended by recent guidelines 1. When performing the examination, it is essential to follow a systematic approach to ensure that all aspects of the abdomen are evaluated.

• Start with inspection, observing the abdomen's contour, symmetry, skin changes, visible pulsations, and any distention or masses.
• Next, auscultate before palpation to avoid altering bowel sounds; listen in all four quadrants for bowel sounds (normally 5-30 per minute) and for bruits over major vessels.
• For percussion, systematically tap across all quadrants to detect tympany (gas-filled areas), dullness (solid organs or fluid), and assess liver span.
• Proceed to light palpation using your fingertips to detect tenderness, guarding, or superficial masses, covering all quadrants.
• Follow with deep palpation using the flat part of your fingers to feel deeper structures, including the liver edge, spleen, and any abnormal masses.
• Check for specific signs like Murphy's sign for cholecystitis (pain with deep inspiration during right upper quadrant palpation) and rebound tenderness for peritoneal inflammation, as these can indicate severe disease 1.
• Conclude by assessing for ascites using shifting dullness or fluid wave tests if distention is present. Throughout the examination, maintain a warm, professional demeanor, explain what you're doing, and observe the patient's face for signs of discomfort, as patient comfort and cooperation are crucial for an accurate assessment 1.

From the Research

Abdominal Physical Examination

To perform an abdominal physical examination, several steps and techniques are involved. The examination is a crucial diagnostic tool that can help identify various abdominal pathologies and minimize the need for further testing or radiation 2, 3.

Steps Involved in the Examination

• The examination typically begins with inspection, followed by auscultation, percussion, and palpation 3, 4.
• The patient's abdomen is inspected for any visible signs of distension, scars, or other abnormalities.
• Auscultation is performed to listen for bowel sounds, which can indicate the presence of obstruction or other gastrointestinal issues 5, 6.
• Percussion is used to assess the abdominal organs and detect any areas of tenderness or abnormalities.
• Palpation is a critical component of the examination, as it allows the clinician to detect tenderness, masses, or other abnormalities through touch 4.

Importance of Palpation

• Abdominal palpation is a difficult skill to master, but it is essential for detecting tenderness and expressing pain 4.
• Various techniques and medical eponyms are associated with abdominal palpation, which can help clinicians detect disease and differentiate between conditions based on location and response to palpation 4.

Clinical Application

• The abdominal physical examination is a valuable tool in the diagnosis and management of patients with abdominal symptoms or pathologies 2, 5.
• The examination can help identify signs of peritonitis, obstruction, or other acute and subtle abnormalities of the abdomen 5, 6.
• A thorough understanding of the clinical anatomy and application of the abdominal physical examination is vital for making accurate diagnoses and providing effective patient care 3.