ABDOMINAL EXAMINATION

M.THAMRIN TANJUNG

 Abdominal examination empty her bladder before the abdominal examination. lying semi-recumbent, with a sheet covering her

 It is usual to examine the woman from her right-hand side. Abdominal examination comprises inspection, palpation, percussion and appropriate,auscultation.

Inspection
The contour of the abdomen should be inspected and noted. There may be an obvious distension or mas The presence of surgical scars, dilated veins or striae gravidarum (stretch marks) should be noted. It is important specifically to examine the umbilicus for laparoscopy scars and just above the symphysis pubis for Pfannenstiel scars (used for Caesarean section, hysterectomy, etc.). The patient should be asked to raise her head or cough and any herniae or divarication of the rectus muscles will be evident.

Palpation
First, if the patient has any abdominal pain, she should be asked to point to the site. This area should not be examined until the end of palpation. It is usual to get the patient to cough, as she may show signs of peritonism. Palpation using the right hand is performed, examining the left lower quadrant and proceeding in a total of four steps to the right lower quadrant of the abdomen.

Palpation
Palpation should include examination for masses, liver, spleen and kidneys. If a mass is present but it is possible to palpate below it, it is more likely to be an abdominal mass rather than a pelvic mass. It is important to remember that one of the characteristics of a pelvic mass is that one cannot palpate below it.

Palpation
If the patient has pain, her abdomen should be palpated gently and the examiner should look for signs of peritonism, i.e. guarding and rebound tenderness. The patient should also be examined for inguinal herniae and lymph nodes.

Percussion
Percussion is particularly useful if free fluid is suspected. In the recumbent position, ascitic fluid will settle down into a horseshoe shape and dullness in the flanks can be demonstrated. As the patient moves over to her side, the dullness will move to her lowermost side; this is known as 'shifting dullness'. A fluid thrill can also be elicited. An enlarged bladder due to urinary retention will also be dull to percussion and this should be demonstrated to the examiner (many pelvic masses have disappeared after catheterization

Auscultation
This method is not specifically useful for the gynaecological examination. However, a patient will sometimes present with an acute abdomen with bowel obstruction or a postoperative patient with ileus, and therefore listening for bowel sounds may be appropriate.