The abdominal exam, in medicine, is performed as part of a physical examination, or when a patient presents with abdominal pain or a history that suggests an abdominal pathology.

The exam includes several parts:

• position/lighting/draping
• inspection
• palpation
• percussion
• auscultation

Position/Lighting/Draping

Position - patient should be supine and the bed or examination table should be flat. The patient's hands should remain at her sides with her head resting on a pillow. If the head is flexed, the abdominal musculature becomes tensed and the examination made more difficult. Allowing the patient to bend her knees so that the soles of her feet rest on the table will also relax the abdomen.

Lighting - adjusted so that it is ideal.

Draping - patient should be exposed from the pubic symphysis to the above the costal margin - in women to just below the breasts.

Inspection

Patient should be examined for

• masses
• scars
• lesions
• signs of trauma
• bulging flanks - best done from the foot of the bed
• jaundice/scleral icterus
• abdominal distension

Stigmata of liver disease

• spider angiomata
• temporal wasting
• fetor hepaticus

=Hands

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• clubbing
• thenar wasting
• Dupuytren's contracture
• palmar erythema

=Estrogen related

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• spider nevi

=Estrogen-related in males

=

• testicular atrophy
• gynecomastia

=Associated with portal hypertension

=

• hematochezia (blood in stool)
• hematemesis - gastric bleed, esophageal varices
• caput medusae (rare) - venous distension
• ascites

Auscultation

Auscultation is typically done before percussion and palpation, unlike in other examinations. It is performed first because vigorously touching the abdomen may disturb the intestines, perhaps artificially altering their activity and thus the bowel sounds. Additionally, it is the least likely to be painful/invasive; if the person has peritonitis and you do rebound tenderness and then want to auscultate you may no longer have a cooperative patient.

Pre-warm the diaphragm of the stethoscope by rubbing it on the front of your shirt before beginning auscultation. One should auscultate in all four quadrants, but there is no true compartmentalization so sounds produced in one area can generally be heard throughout the abdomen. To conclude that bowel sounds are absent one has to listen for 1 minute. Growling sounds may be heard with obstruction. Absence of sounds may be caused by peritonitis.

Percussion

• all four quadrants
• percuss the liver span

Examination of the spleen

• Castell's sign or alternatively Traube's space

Palpation

• All four quadrants - light then deep.
• Start away from the painful point.
• In light palpation, note any palpable mass.
• In deep palpation, detail examination of the mass, found in light palpation, and Liver & Spleen

Other

• Digital rectal exam - Abdominal examination is not complete without a digital rectal exam.

Special maneuvers

=Suspected cholecystitis

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• Murphy's sign

=Suspected appendicitis or peritonitis

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• obturator sign
• psoas sign
• rebound tenderness
• Rovsing's sign

=Hepatomegaly

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• scratch test

Examination for ascites

• bulging flanks
• fluid wave test
• shifting dullness

External links

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• Abdominal exam - a practical guide to clinical medicine from the University of California, San Diego.
• Videos of the abdominal exam - Beth Israel Deaconess Medical Center, Harvard Medical School

Diagnostic gastroenterology | Physical examination