Abdomen examination

The abdominal exam, in medicine, is performed as part of a physical examination, or when a patient presents with abdominal pain or a history that suggests an abdominal pathology.

The abdominal exam has conventionally been split into different stages:

• Preparation/Positioning of the patient.
• Inspection of the patient and their the visible characteristics of their abdomen.
• Auscultation of the abdomen with a stethoscope.
• Palpation of the patient's abdomen and abdominal organs.
• Percussion of the patient's abdomen.
• Special tests performed based on the need to inspect for signs of various abdominal disease

Inspection

The abdominal exam typically begins a visual examination of the abdomen. Some common things an examiner might look for are:

• masses
• scars
• lesions
• abdominal distension

In addition, a doctor might look/check for specific signs of disease, such as:

• spider angiomata
• caput medusae
• ascites

Auscultation

Auscultation refers to the use of a stethoscope by the examiner to listen to sounds from the abdomen. This is a very subjective procedure.

Unlike other physical exams, auscultation is performed prior to percussion or palpation, because both might alter abdominal sounds.

Some controversy exists as to the length of time required to confirm or exclude bowel sounds, with suggested durations up to seven minutes. Bowel obstruction may present with grumbling bowel sounds or high-pitched noises. Healthy persons can have no bowel sounds for several minutes  and intestinal contractions can be silent. Absence of sounds may be caused by peritonitis, paralytic ileus, bowel obstruction, intestinal ischemia or other causes.Some authors suggest that listening at a single location is enough as sounds can be transmitted throughout the abdomen.

The examiner also typically listens to the two renal arteries for bruits by listening in each upper quadrant, adjacent to and above the umbilicus. Bruits heard in the epigastrium that are confined to systole are considered normal.

Palpation

The examiner typically palpates all nine areas of the patient's abdomen. This is typically performed twice, lightly and then deeply.

On light palpation, the examiner tests for any palpable mass, rigidity, or pain.

On deep palpation, the examiner is testing for and organomegaly, including enlargement of the liver and spleen.

Reactions that may indicate pathology include:

• guarding, describing muscle contraction as pressure is applied.
• rigidity, indicating peritoneal inflammation.
• rebound, pain on release
• hernial orifices if positive cough impulses.

Percussion

The examiner, mindful of areas of discomfort, begins by palpating areas of no pain. Percussion is performed by knocking the middle finger against the phalanx of the middle finger of the opposing hand, which rests against the surface of the abdomen in each of the nine areas tested. Percussion can elicit a painful response in the patient, and may also reveal whether there is abnormal levels of fluid in the abdomen. Organomegaly may also be noted, including gross splenomegaly (enlargement of the spleen), hepatomegaly (enlargement of the liver), and urinary retention.

The examiner, when percussing for organomegaly, percusses in a particular manner:

• percuss the liver from the right iliac region to right hypochondrium
• percuss for the spleen from the right iliac region to the right hypochondrium and the left iliac to the left hypochondrium.

Examination of the spleen