Abdominal Exam
•Inspection
•Auscultation
•Percussion
•Palpate
percussion includes percussion of
liver span, light and deep
palpation, palpation of liver edge,
spleen tip, kidneys, and aorta. The
abdominal exam is done with the
patient supine at 90o
Order of exam is critical. Auscultate BEFORE
palpating!
ABDOMEN: Inspection
There should be
adequate
exposure of the
abdomen for
proper inspection.
The patient
should be
exposed from the
inferior chest to
the anterior iliac
spines bilaterally.
124: Auscultation
Auscultation can be
done with the
diaphragm or the bell;
most examiners use
the diaphragm. You
should listen for at
least 10-15 seconds
and note the pitch
and frequency of
bowel sounds. If you
do not hear any bowel
sounds, you should
listen for a full two
minutes before you
can state that the
patient does not have
any bowel sounds.
Bowel sounds should
occur from every other
second to every 12
seconds.
Note: During the
abdominal exam auscultation is done
before palpation
Percussion 125126
Percussion: the left and right abdomen should be percussed
above and below the umbilicus. Most examiners will percuss 8
or more areas.
Percussion: Liver span
The liver span is estimated by percussion.
Remember that it is easier to hear the
change from resonance to dullness – so
proceed with percussion from areas of
resonance to areas of dullness.
Upper border: In the midclavicular line start
percussing in the chest moving down towards the
abdomen about ½ to 1 cm at a time. Note where the
percussion notes change from resonate to dull.
Lower border: In the midclavicular
line begin percussion below the
unbillicus and proceed upward until
dullness is encounter.
The distance between the
two areas where dullness is
first encountered is the liver
span.
Liver span is normally 6 to 12 cm in
the midclavicular line.
Liver Span: Scratch Test
Start in the same areas
above and below the
liver as you would with
percussion. Instead of
percussing lightly,
scratch moving your
finger back and forth
while listening over the
liver. Since sound is
conducted better in
solids than in air, when
the louder sounds are
heard you are over the
liver. Mark the superior
and inferior boarders of
the liver span in the
midclavicular line
Abdominal Palpation
128, 129. Palpate lightly in all 4
quadrants. Press down around 1 cm.
Remember to look at the patient’s face
during palpation to see if any
tenderness is elicited
Palpation: Deeply, all 4
quadrants
One should use two hands. Press
down around 4 cm
Palpation: Liver
Stand on the pt’s right side. Place your left hand behind the
patient’s R side under the 11th and 12th rib area. Press upward
with the L hand.
Place your R hand on the pt’s
abdomen well below where you
percussed the liver edge
130-131: Palpation of Liver: Alternative Method
It is acceptable during palpation of the liver to
use both hands to palpate abdomen. You use
the fingers of one hand to palpate and the other
hand is used to apply pressure to the dorsum of
the other hand. Thus the hand you are using to
palpate does not need to be used to apply
pressure.
132-133: Palpation: Spleen
Palpation: Spleen
(correctly - position,
breaths, palpating
deepest full
inspiration, 1 hand
under L side, 1
feeling)
Palpation: Spleen (if
not palpable, R lateral
decubitus)
Right
lateral
decubitus
135-136: Palpation of Kidneys
Right kidney (take a deep
breath, capture kidney, exhale,
slowly release kidney
Left kidney (take a deep breath,
capture kidney, exhale, slowly release
kidney)
137: Palpation: For
abdominal aorta
Palpation: For
abdominal aorta (to
feel both the left and
right walls of the
aorta)
In correct order:
Inspection,
auscultation,
percussion and
palpation
Abdominal
Examination was
done at 0.