With the tip of the middle finger of your dominant hand, strike the distal interphalangeal joint 2–3 times. Place the middle finger of your non-dominant hand against the abdominal wall.Palpation of the inguinal lymph nodes : (see examination of the lymph nodes)Ībdominal tenderness may be a sign of numerous conditions ( see differential diagnosis of acute abdomen and differential diagnoses of abdominal pain ).Asking the patient to lie on their right side may facilitate palpation of an enlarged spleen.Repeat 10 cm below the left costal margin. Place the pads of your fingers lateral to the belly button and palpate as you move towards the left upper quadrant.Asking the patient to take a deep breath may facilitate palpation of the liver, as the movement of the diaphragm will move the liver toward your hand.Continue until you feel the liver or reach the costal margin. Palpate as you move towards the right upper quadrant and attempt to feel for the edge of the liver. 10 cm below the costal margin at the mid-clavicular line. Place the pads of your fingers over the right upper quadrant, approx.Voluntary guarding: voluntary contraction in order to avoid pain during the examination and is often generalized over the entire abdomen.Involuntary guarding (also referred to as " rigidity"): involuntary tightening of the muscles due to peritoneal inflammation and is often localized to a specific abdominal quadrant.Abdominal guarding: patient contraction of the abdominal wall muscles during palpation.Caused by irritation of the receptors in parietal peritoneum Rebound tenderness: abrupt increase in pain when an examiner suddenly releases compression of the abdominal wall.Deep palpation in all four quadrants: to assess intraabdominal organs (potential signs of peritonitis).Superficial palpation: to assess for superficial or abdominal wall processes.Observe the patient's face during abdominal palpation, as it is the main indicator of the intensity and location of pain.If so, begin palpation in the non-painful area. Prior to palpation, ask the patient whether they have abdominal pain or tenderness.Purpose: to evaluate internal organs and identify any sources of pain (if present).Normal findings: tympanic sound over air-filled stomach/intestinal sections muffled sounds over fluid-filled or solid organs ( liver, spleen ).Purpose: to determine the size and location of intra-abdominal organs.Normal findings : : gurgling bowel sounds every 5–10 sec.Note the general contour of the abdomenĪuscultation of the abdomen should be performed prior to percussion and palpation, as physical manipulation of the abdomen may induce a change in bowel sounds.Note any scars, striae, vascular changes (e.g., caput medusae), or protrusions.If your hands are cold, warn the patient prior to palpating the abdomen.Instruct the patient to lie down and expose the patient's abdomen.
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