Abdominal Anatomy
Most of the abdominal organs are found within the peritoneum. These
organs can and do "move" (during pregnancy for example). Certain
structures, such as the kidneys and pancreas, are retroperitoneal.
•
oLeft Upper Quadrant
oLeft Lower Quadrant
• Three central areas:
o Epigastric
o Periumbilical
o Suprapubic
Inspection
Auscultation
Percussion
Palpation
Special Tests
Inspection
Auscultation
Unlike other regions of the body, auscultation comes before percussion and
palpation (the sounds may change after manipulation). Record bowel sounds as
being present, increased, decreased, or absent.
Bruits
Percussion
Splenic Enlargement
Palpation
Begin with light palpation. At this point you are mostly looking for areas of
tenderness. The most sensitive indicator of tenderness is the patient's facial
expression. Voluntary or involuntary guarding may also be present.
Deep Palpation
To palpate the liver edge, place your fingers just below the costal margin
and press firmly. Ask the patient to take a deep breath. You may feel the edge of the
liver press against or slide under your hand. A normal liver is not tender.
An alternate method for palpating the liver uses hands "hooked" around the
costal margin from above. The patient should be instructed to breath deeply to force
the liver down toward your fingers.
Press down just below the left costal margin with your right hand while
asking the patient to take a deep breath. It may help to use your left hand to lift the
lower rib cage and flank. The spleen is not normally palpable on most individuals.
Special Tests
• Rebound Tenderness
• Costovertebral Angle Tenderness
• Shifting Dullness
Rebound Tenderness
This is a test for peritoneal irritation. Palpate deeply and then quickly
release pressure. If it hurts more when you release, the patient has rebound
tenderness.
CVA tenderness is often associated with renal disease. Use the heel of your
closed fist to strike the patient firmly over the costovertebral angles.
Shifting Dullness
Things to Remember
• Consider inguinal/rectal examination in males.
• Consider pelvic/rectal examination in females.
• Disorders in the chest will often manifest with abdominal symptoms. It is
always wise to examine the chest when evaluating an abdominal complaint.