EXAMINATION OF THE ABDOMEN

Introduce yourself
Ask permission
Position Patient lying FLAT with arms at side
Proper exposure Ideally, nipples to knees
Realistically, expose only the chest and the abdomen

1) INSPECTION
General
- Stand at foot of bed and inspect patient
- Abdomen distended or scaphoid distension due to fat, fluid, faeces, flatulence, or
filthy big tumor
- Comment on the umbilicus: inverted or everted?
- Any noticeable scars?
- Any obvious masses?
- Comment on hair distribution in males with liver disease, there is gynaecomastia
- Any visible striae?
- Any spider naevi? occur in alcoholic cirrhosis
- Look for signs of cardiopulmonary distress

Hands
- Feel for temperature e.g. warm/cold
- Feel for moisture e.g. moist/dry
- Look for peripheral cyanosis (bluish discolouration of nails)
- Look for palmar erythema (reddening of the palms, particularly thenar and
hypothenar eminences) due to chronic liver disease
- Look for leuconychia (opacification of the nail bed leaving only a rim of pink nail
bed at the top of the nail)
- Look for koilonychia (dry, rigid, brittle, spoon-shaped nails) due to severe Fe
deficiency
- Look for Duputryens contracture (thickening and contraction of the palmar fascia
causing permanent flexion mostly of the ring finger)
- Check for flapping tremor (asterixis)

Arms
- Look for bruising, petechiae, or ecchymosis due to clotting abnormalities as in
chronic liver disease
- Look for scratch marks indicated jaundice

Face
- Eyes Mucus membranes pink and moist
Check for icterus
- Mouth Look at dentition
 Look under the tongue:
Leucoplakia? a white coloured thickening of the mucosa of the
tongue
Glossitis? smooth tongue which may also be erythematous. Occurs
in deficiencies of Vit B12, folate or iron
Look for angular stomatitis iron deficiency

2) PALPATION
Neck
- Palpate cervical lymph nodes
- Palpate supraclavicular lymph nodes may be enlarged in gastric Ca

Abdomen
- Light palpation for tenderness, masses and guarding.
- Deep palpation
- Any rebound tenderness?
- Palpate for organs
Liver Comment on texture and liver edge if palpated
Features of the liver: smooth edge, cannot get above it, moves with
respiration, dull to percussion, not ballotable
Spleen Start from RIF and proceed to lower costal margin
Roll patient to right side to palpate
Features of the spleen: smooth edge, moves with respiration, cannot
get above it, dull to percussion, not ballotable

Kidney Bimanual palpation (Ballote kidneys)

Features of kidney: band of resonance on percussion

3) PERCUSSION
Percuss for fluid (ascites) or masses

Ascites Demonstrate dullness in both flanks

Demonstrate shifting dullness
Demonstrate fluid thrill

4) AUSCULTATION
Bowel sounds soft, gurgling characteristic. Occur every 5-10s
Renal bruit

Cover patient and say thank you!