Abdominal Examination

Part II

LIU YANFANG, M.D., Ph.D

1st Teaching Hospital
Henan Medical University
血液科 刘延方 博士后

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Palpation, Percussion
& Auscultation

Palpate mass
Percussion
Auscultation
Signs of common diseases.
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 Masses
 Characteristics:
 Location, size, contour,texture, tenderness,
pulsation, movability
 Physical:
 Abdominal wall: venter musculi or tendinous inte
rsections of musculus rectus abdominis
 Abdominal cavity: lumbar centrum, sacral promo
ntory 骶骨岬 , abdominal aorta, inferior pole of rig
ht kidney, transverse colon, sigmoid colon, cecu
m 盲肠

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Masses: Physical

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 Pathological
 Shifting or swelling of parenchymatous 实质的 organ

 Distension of hollow viscus

 Inflammatory masses (abscess or adhesion)

 Tumor or cyst

 Lymphadenectasis 淋巴结肿大

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 Fluidthrill 液波震颤

volume of ascites
>3000ml

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 Succussion Splash
 Caused by increased air and fluid in the
stomach, as seen with pyloric obstruction,
gastric dilatation or large hiatus hernia

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Percussion
 Technique: indirect percussion

 Normal percussion notes:

 Tympany: hollow viscus
 Dullness or flatness: liver, spleen, lumber
muscle, enlarged bladder or uterus

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 Abnormal Percussion Notes

 Enlarged tympany area ： intestinal obstructio

n, perforation of gastrointerstinal tract

 Enlarged dull area: swelling of parenchymatous

organ, tumor, ascites

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Dullness Area of Liver
 Superior border: 1-2 inter
costal spaces higher than
inferior lung border
 Inferior border: 1-2 cm hi
gher than detected by pal
pation
 Liver span:9-11cm (right
midclavicular line)

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 Abnormal Percussion Findings
 Enlarged: hepatic congestion, hepatitis, liver abs
cess, liver carcinoma
 Diminished: liver cirrhosis or necrosis
 Disappeared: perforation of gastrointestinal tract
, abdominal surgery
 Upward shifting : fibrosis or atelectasis of right lu
ng, large volume of air or gas in the gastrointesti
nal tract
 downward shifting: emphysema, right side pleur
al effusion, hepatoptosia 肝下垂

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 Spleen Percussion
 Location:
 9th ~11th ICS alongside left midaxillary line
 Diameter:
 superio-inferior 长度 : 4-7 cm
 The anterior border should not exceed anterior a
xillary line
 Abnormal findings:
 Enlarged: splenomegaly
 Diminished: too much gas in surrounding organs

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Traube’s Area 胃泡鼓音区

 Borders
 Upper: left lung,
diaphragm
 Lower: Rib
 Right: liver
 Left: spleen

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Ascites
 Shifting dullness:
 Free fluid causes air-containing gut to float up to t
he most superior position
 The volume of ascites usually exceeds 1000ml if de
tectable.

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 Ascites

 Puddle sign: a way to detect small amounts of fluid

15
Ascites and Ovarian Cyst

 dullness sites

 Shifting dullness tympany

tympany

Ruler pressing test

dullness
 dullness

Difference of dullness sites

between ascites and ovarian cyst
 Umbilicus 
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 Protruded
umbilicus

ascites
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Ovarian cyst
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  Percussion pain
 Liver area
 Hepatitis
 Liver abscess
 Kidney area
 Nephritis
 Pyelonephritis 肾盂肾炎
 Renal tuberculosis
 Calculus
 perinephritis

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Costovertebral Angle Tenderness

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Percussion of Bladder

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Auscultation
 Bowel sounds
 Principle:peristaltic activity emits various
gurgling and bubbling sounds as air and
fluid interfaces change with contraction
waves.
 Normal: 4~5/min

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 Abnormal:
 Increased: >10/min: hypermotile states such a
s acute gastroenteritis, blood in the small bowe
l
 High-pitched tinkling:intestinal fluid and air under pr
essure, as in early obstruction
 Decreased:postlaparotomy, eletrolyte imbalanc
e, senile constipation
 Absence: acute peritonitis, paralytic ileus
one must listen for at least a full 3 minutes bef
ore pronouncing that peristalsis 蠕动 has ceased

23
 Friction Rub
 Principle:
 Irritated fibrin-laden periton
eal surfaces grate with moti
on, seen in localized peritoni
tis.
 Scratch sound:
 Aids in static border definition
 Inferior border of the liver

 Ascites (<120ml)

Scratch test

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Hepatic Cirrhosis

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Acute Perforated Gastric or
Duodenal Ulcer
 Inspection:forced supine position, decreased
or disappeared abdominal respiration
 Palpation: tenderness in epigatrium or RUQ, r
ebound tenderness, rigid abdominal wall
 Percussion: increased resonance over liver, sh
ifting dullness
 Auscultation: decreased or absence of bowel
sounds

27
 Writing up the physical examination

The abdomen is obese. Bowel sounds are pres

ent. Percussion notes are normal. There is a ar
ea of significant pain in the right lower quadran
t, immediately above the right midposition of t
he inguinal ligament. Rectal examination disclo
ses severe pain in the same area. No organom
egaly is felt.

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QUESTIONS

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