ABDOMINAL EXAMINATION
Anatomy
2. Regions
3. Common presenting symptoms
4. Examination
 Inspection
 Auscultation
 Percussion
 Palpation
 Liver and spleen
5. Specific maneuvers
1.
Regions
Common presenting symptoms of
Gastrointestinal disorders
 Abdominal pain, acute or chronic
 Indigestion, nausea, vomiting including blood, loss of
appetite, early satiety
 Dysphagia / odynophagia
 Diarrhea, constipation
 Jaundice
For each symptom, try to elicit all of its attributes
SOCRATES (site, onset, character, radiation, associated
factors, timing, exacerbating/relieving factors, severity)
Example: Typical pain in Acute
appendicitis
 Site: poorly localized, periumbilical pain followed usually by RLQ
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pain
Onset: vague
Character: dull periumbilical pain, may be cramping
Radiation: periumbilical  RLQ
Associated factors: anorexia, nausea/vomiting, low fever
Timing: Periumbilical (4-6h), RLQ (depends on intervention)
Exacerbating/relieving factors: if subsides temporarily,
suspect perforation of the appendix, movement/cough.
Severity: periumbilical (mild but increasing), RUQ (steady/more
severe)
Inspection
 The skin: scar, striae, dilated vein, rashes and lesions
 The umbilicus: contour, inflammation, bulges
 The contour of the abdomen: flat, rounded,
protuberant, scaphoid
 Peristalsis
 Pulsations: abdominal aorta in the epigastric region.
SCAR
PINK-PURPLE STRIAE OF CUSHING’S SYNDROME
DILATED VEIN OF HEPATIC CIRRHOSIS
RASHES
UMBILICAL HERNIA IN NEWBORN
Contour of the abdomen
PROTUBERANT
SCAPHOID
(newborn with diaphragmatic
hernia)
AUSCULTATION
 Before performing percussion and palpation because these
maneuvers can alter the bowel sound
 Bowel sounds (5-34/min)
diarrhea, intestinal obstruction
paralytic ileus, peritonitis
 Bruits (renal artery stenosis)
PERCUSSION
 Percuss lightly in all four quadrant
 Distribution of tympany and dullness.
PALPATION
 Light palpation: tenderness, muscular resistance, superficial
organs and masses.
 Deep palpation: delineate abdominal masses
 Assessment for peritoneal inflammation:
Cough  Palpation (guarding, rigidity)  rebound tenderness
LIVER
 Percussion
 Palpation
SPLEEN
 Percussion: 2 techniques
 Percuss the left lower anterior chest wall
 Check splenic percussion sign
 Palpation
Time for test!
A
D
C
C
 “Abdomen is protuberant with active bowel sounds. It is soft
and non-tender; no masses or hepatosplenomegaly. Liver
span is 7 cm in the right midclavicular line; edge is smooth
and palpable 1 cm below the right costal margin. Spleen not
felt”
 “Abdomen is flat. No bowel sounds heard. It is firm and
boardlike, with increased tenderness, guarding, and rebound
in the right midquadrant. Liver percusses to 7 cm in the
midclavicular line; edge not felt. Spleen not felt”
VN  English
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Ăn uống bình thường, đi cầu bình thường
Không đau bụng, không nôn, không buồn nôn
Bụng không chướng,
Âm ruột bình thường, không nghe tiếng thổi động mạch
Bụng mềm, không đau, không sờ thấy u cục
Gan 1cm dưới bờ sườn, cao 8 cm trên đường trung đòn, lách không lớn
 No anorexia (no change in dietary patterns), no diarrhea or constipation (no
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abnormalities in stool patterns or characteristics)
No abdominal pain, no nausea or vomiting
No abdominal distension
Bowel sounds present (active bowel sounds), no bruits
Abdomen soft and non-tender, no masses,
Liver span is 8 cm in the right midclavicular line, edge is palpable 1 cm below the RCM
Speen not felt (no spleenomegaly)