Abdominal Exam

History
Common Complaints:
o Abdominal pain o Change in bowel habits
o Change in appetite o Melena/Hematochezia
o Dysphagia/Odynophagia • Dark tarry or red
• Difficult or painful stools
swallowing o Hemorrhoids
o Nausea/Vomiting o Anal pruritis
o Jaundice

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 Anatomy
Regions (Anatomical) Quadrants (Clinical)

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Surface Anatomy

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 Enhancing the Exam
• Empty bladder
• Patient comfort (pillows and draping)
• Arms at side or crossed over chest
• Ask the patient to point to any painful areas; examine last
• Warm hands and stethoscope
• Ticklish or nervous patients: slow movements, distraction, use
their hands

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 Exam Order
• Inspection
• Auscultation
o Percussion or palpation can alter bowel sound frequency
o Bonus Question: What is the medical term for “stomach growling”?
• Borborygmus
• Percussion
• Palpation

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 Abdominal Physical Exam
Inspection
Skin Contour
Scars – cicatrix Flat
Striae Scaphoid
Discoloration Distended
Venous patterns Symmetry
Edema Movement
Peristaltic
Respirations
Aortic pulsation

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Abdominal Physical Exam
Auscultation
• 4 quadrants
• 15-20 seconds
• Bowel sounds
o Frequency
o Pitch
• Vascular Sounds
o Renal
o Iliac
o Femoral

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 Abdominal Physical Exam
Percussion
• Notes Elicited
o Tympanic
• Predominant due to gas in GI tract
o Hyperresonant
o Dull
• Organs, fluid and feces
o Flat

• Distension of abdomen
o Fluid vs. Air

• Outline Organs
o Liver, spleen, and gastric bubble

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 Abdominal Physical Exam
Palpation
• Start farthest from pain and move towards it
• 4 abdominal quadrants
o Light palpation
o Deep palpation

• Peritoneal inflammation
o Pain with coughing, gentle palpation
o Involuntary rigidity
o Rebound tenderness

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 Abdominal Physical Exam
Palpation - Left Upper Quadrant
• Liver: left lobe
• Spleen
• Stomach
• Jejunum and proximal
ileum
• Pancreas: body and tail
• Left kidney
• Left suprarenal gland
• Left colic (splenic)
flexure
• Transverse colon: left
half
• Descending colon:
superior part
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 Abdominal Physical Exam
Palpation - Right Upper Quadrant
 Liver: right lobe
 Gallbladder – Murphy’s sign
 Stomach: pylorus
 Duodenum: parts 1-3
 Pancreas: head
 Right suprarenal gland
 Right kidney
 Right colic (hepatic) flexure
 Ascending colon: superior
part
 Transverse colon: right half

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 Abdominal Physical Exam
Palpation - Right Lower Quadrant
 Cecum
 Vermiform appendix
 McBurney’s Point
 Rovsing’s sign
 Psoas sign
 Obturator sign
 Most of ileum
 Ascending colon: inferior
part
 Right ovary
 Right uterine tube
 Right spermatic cord
 Uterus (if enlarged)
 Urinary bladder (if full)

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Walgreens.com 14
 Abdominal Physical Exam
Palpation - Left Lower
Quadrant
• Sigmoid colon
• Descending colon:
inferior part
• Left ovary
• Left uterine tube
• Left ureter: abdominal
part
• Left spermatic cord:
abdominal part
• Uterus (if enlarged)
• Urinary bladder (if full)

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• Abdominal Aorta
• Inguinal Lymph Extras
Nodes
• Costovertebral angle
(CVA) tenderness

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 Abdominal Physical Exam
Practice- 20 Minutes
• Palpate • Inspection
o General palpation – Contour
o Liver
– Skin
o Gallbladder
o Spleen – Movement
o R and L kidneys • Auscultation
o Abdominal aorta – Bowel sounds
o Inguinal lymph nodes – Vascular sounds
• Special: • Percussion
o Murphy’s sign
o McBurney’s point – Abdomen for masses or fluid
o Rovsing’s sign – Liver span
o Psoas sign – Spleen
o Obturator sign – Gastric bubble
o Rebound tenderness
o CVA tenderness

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