Abdominal Examination
| Step | Action |
| Preparation | Wash hands, introduce yourself, confirm patient identity, explain procedure, and obtain consent. |
| Position patient supine with arms by sides; expose abdomen from xiphisternum to pubic symphysis. | |
| Inspection | Hands: Check for pallor, palmar erythema, and Dupuytren’s contracture Inspect nails for koilonychia and leukonychiaAssess for finger clubbing andasterixis Compare hand temperaturePalpate for Dupuytren’s contracture |
| Arms & Axillae: Inspect arms for bruising, excoriations, and needle track marks Check axillae for acanthosis nigricans and hair loss | |
| Face: Eyes: Look for conjunctival pallor, jaundice, corneal arcus, xanthelasma and Kayser-Fleischer rings Mouth: Inspect for angular stomatitis, glossitis, oral candidiasis, and aphthous ulcers | |
| Neck: Palpate for lymphadenopathy in the supraclavicular fossae, especially Virchow’s node (left supraclavicular fossa) | |
| Chest: Inspect for spider naevi, gynaecomastia, and hair loss | |
| Abdomen: Inspect for scars, Cullen’s sign, Grey-Turner’s sign, striae, abdominal distension, hernias, and stomas | |
| Palpation | Light Palpation: Gently palpate all 9 regions for tenderness or superficial masses. |
| Deep Palpation: Apply more pressure to assess for deeper masses, organomegaly, or abnormal pulsations. | |
| Liver Palpation: Use the right hand to palpate the liver edge by placing fingers below the right costal margin and asking the patient to take a deep breath. | |
| Spleen Palpation: Palpate the left costal margin to feel for splenomegaly | |
| Kidney Palpation: Place one hand anteriorly and the other posteriorly on the flank to palpate for kidney enlargement. | |
| Percussion | Percuss liver, spleen and bladder: Percuss all regions for resonance (normal) or dullness (possible mass or fluid). |
| Shifting Dullness: Percuss from the midline to the flank while the patient is supine. Ask the patient to turn onto their side and wait a few seconds to allow fluid to shift. Repeat percussion in the same area—a shift in dullness indicates the presence of ascites. Previously dull areas (flank) may become resonant if the fluid has moved away. | |
| Auscultation | Bowel sounds: note whether they are present, absent, or high-pitched. |
| Vascular Bruits: Auscultate over the aorta and renal arteries to assess for bruits. | |
| Special Tests | Rebound Tenderness: Press gently into the abdomen and then release quickly. Pain upon release suggests peritonitis. |
| Murphy’s Sign: Palpate the right upper quadrant during inspiration. Pain or a sudden halt in inspiration suggests cholecystitis. | |
| Rovsing’s Sign: Press deeply in the LLQ and check for referred pain in the RLQ, which could indicate appendicitis. | |
| Completion | Thank the patient, help them cover up, wash hands, and document findings. |
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