Abdominal Examination

Introduction

• Wash hands, Introduce, Explain, Permission

• Exposure, Position, Pain

• Surrounding

General Examination

• Hands

  • Flapping tremor

  • Signs of chronic liver disease: clubbing, leuconychia,palmar erythema

  • AV fistula

  • Tattoo marks, scratch marks, muscle wasting

• BP, JVP

• Face

  • Pallor, Jaundice

  • Mouth - angular stomatitis, cheilitis,parotid enlargement

• Neck

  • Lymph nodes

• Chest and upper back

  • Spider naevi

Inspection

• Inspect the abdomen for any visible peristalsis, pulsations, distension, asymmetry, or masses

• Any hernia orifices intact or not?

Palpation

• Begin with light palpation to assess for tenderness, guarding, and superficial masses

• Move on to deep palpation to assess for organomegaly or deep masses

• Assess for hepatosplenomegaly and any palpable masses in the liver or spleen

• Assess for any palpable or ballotable kidneys

Percussion

• Assess for any areas of dullness or tympany, which can indicate the presence of fluid or air, respectively

• Liver and splenic dullness

Auscultation

• Listen for bowel sounds in all four quadrants, assessing both frequency and character

• Assess for any bruits in the abdominal aorta and renal arteries

Additional Examination

• Perform a rectal exam if necessary to assess for any masses, tenderness, or blood in the stool

• Consider performing a vaginal exam in females to assess for any masses or tenderness in the uterus or ovaries