From the Guidelines
To perform a physical examination of the abdomen, begin by ensuring patient comfort in a supine position with exposed abdomen and proper draping, and then proceed with inspection, auscultation, percussion, and palpation to identify any abnormalities or tenderness, 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 condition, 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 the abdomen to identify areas of tympany (gas-filled) or dullness (solid organs, fluid), paying special attention to liver and spleen borders.
- During palpation, begin with light touch across all quadrants to detect tenderness or guarding, then progress to deep palpation to feel for masses or organomegaly. The examination may also include special maneuvers, such as checking for fluid wave or shifting dullness in suspected ascites, and assessing for costovertebral angle tenderness, as noted in the guidelines for sigmoid volvulus management 1. Throughout the examination, maintain communication with your patient, explaining each step and watching for signs of discomfort, which is crucial for building rapport and ensuring patient dignity, and is supported by the most recent evidence 1.
From the Research
Abdominal Physical Examination
To perform an abdominal physical examination, the following steps can be taken:
- Auscultation: listening to the bowel sounds with a stethoscope to assess for any abnormalities 2, 3
- Palpation: gently pressing on the abdomen to check for tenderness, masses, or other abnormalities 2, 3
- Percussion: tapping on the abdomen to check for any areas of tenderness or abnormalities 2, 3
- Rebound tenderness: checking for tenderness when pressing on the abdomen and then quickly releasing 3
Advanced Maneuvers
Advanced maneuvers that can be performed during an abdominal physical examination include:
- Rovsing sign: checking for tenderness in the right lower quadrant when pressing on the left lower quadrant 3
- Psoas sign: checking for tenderness when extending the hip to assess for any abnormalities in the psoas muscle 3
- Obturator sign: checking for tenderness when rotating the hip to assess for any abnormalities in the obturator muscle 3
Clinical Anatomy and Application
Knowledge of the clinical anatomy of the abdomen is vital for making diagnoses and performing a thorough physical examination 4. Understanding the anatomy and application of the abdominal physical examination can help clinicians to make accurate diagnoses and provide appropriate treatment.
Common Abdominal Signs and Symptoms
Common abdominal signs and symptoms that can be assessed during a physical examination include:
- Abdominal pain and distension 5
- Nausea and vomiting 5, 6
- Diarrhea or constipation 5
- Abdominal tenderness or masses 2, 3, 6
Special Patient Populations
When performing an abdominal physical examination on special patient populations, such as critically ill patients, it is important to consider the potential for abdominal complications and to use additional tools, such as intra-abdominal pressure monitoring, to assess for any abnormalities 5.