Abdominal examination - wikipedia Abdominal examination hide This article has multiple issues. Please help improve it or discuss these issues on the talk page. ( Learn how and when to remove these template messages ) This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. ( January 2008 ) This article may be too technical for most readers to understand. Please help improve it to make it understandable to non-experts, without removing the technical details. ( February 2012 ) Abdominal examination Medical diagnostics Abdominal 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 Purpose as part of a comprehensive physical exam The abdominal exam has conventionally been split into different stages : Preparation / Positioning of the patient. Inspection of the patient and 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 diseases. Contents 1 Purpose 2 Positioning and environment 3 Inspection 4 Auscultation 5 Palpation 6 Percussion 7 Other and special maneuvers 8 References 9 External links Purpose According to Mosby 's, `` The abdominal exam is performed as part of the comprehensive physical examination or when a patient presents with signs of symptoms of an abdominal disease process. '' In other words, your doctor will often perform an abdominal exam as part of a routine examination. However, your doctor might perform additional tests if your doctor feels that you might have an abdominal disease. Positioning and environment A suggested position is for the patient to be supine ( on their back ), with their arms to their sides. The patient should be placed in an environment with good lighting, and should be draped with towels or sheets to preserve privacy and warmth Although physicians have had concern that giving patients pain medications during acute abdominal pain may hinder diagnosis and treatment, separate systematic reviews by the Cochrane Collaboration and the Rational Clinical Examination refute this. 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, as both of these could alter the regularity of bowel 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. A prospective study published in 2014 where 41 physicians listened to the bowel sounds of 177 volunteers ( 19 of which had bowel obstructions and 15 with an ileus ) found that `` Auscultation of bowel sounds is not a useful clinical practice when differentiating patients with normal versus pathologic bowel sounds. The listener frequently arrives at an incorrect diagnosis. Agreement between raters was also low ( 54 % ). ''. This article suggests focusing on other indicators ( flatus, pain, nausea ) instead. There is no research evidence that reliably corroborates the assumed association between bowel sounds and gastro - intestinal motility status. 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 A Bangladeshi doctor palpating the abdomen of a female patient. 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 Castell 's sign or alternatively Traube 's space Other and special maneuvers Examination of pelvic lymph nodes Digital rectal exam -- Abdominal examination is not complete without a digital rectal exam. Pelvic examination only if clinically indicated. Special manevures may also be performed, to elicit signs of specific diseases. These include Gallbladder : Murphy 's sign Appendicitis or peritonitis : Psoas sign -- pain when tensing the psoas muscle Obturator sign -- pain when tensing the obturator muscle Rovsing 's sign -- pain in the right iliac fossa on palpation of the left side of the abdomen Carnett 's sign -- pain when tensing the abdominal wall muscles Patafio 's sign -- pain when the patient is asked to cough whilst tensing the psoas muscle Cough test -- pain when the patient is asked to cough Suspected Pyelonephritis : Murphy 's punch sign Hepatomegaly : Liver scratch test Ascites : bulging flanks, fluid wave test, shifting dullness References Jump up ^ Seidel, Henry M. ; Ball, Jane W. ; Dains, Joyce E. ; Flynn, John A. ; Solomon, Barry S. ; Stewart, Rosalyn W. ( 2011 ). Mosby 's Guide to Physical Examination ( 7th ed. ). St. Louis, MO : Elsevier. pp. 492 -- 513. ISBN 978 - 0 - 323 - 05570 - 3. Jump up ^ Manterola C, Vial M, Moraga J, Astudillo P ( 2011 ). Manterola C, ed. `` Analgesia in patients with acute abdominal pain ''. Cochrane Database of Systematic Reviews ( 1 ) : CD005660. doi : 10.1002 / 14651858. CD005660. pub3. PMID 21249672. Jump up ^ Ranji SR, Goldman LE, Simel DL, Shojania KG ( 2006 ). `` Do opiates affect the clinical evaluation of patients with acute abdominal pain ? ''. JAMA. 296 ( 14 ) : 1764 -- 74. doi : 10.1001 / jama. 296.14. 1764. PMID 17032990. ^ Jump up to : MD, Lynn B. Bates ' Guide to Physical Examination and History - Taking, 11th Edition. Lippincott Williams & Wilkins, 11 / 2012. Jump up ^ McGee, S, Evidence - Based Physical Diagnosis, 3rd Edition. Philadelphia, PA : Elsevier - Saunders ; 2012 Jump up ^ http://blogs.jwatch.org/frontlines-clinical-medicine/2017/03/01/listening-bowel-sounds-outdated-practice/ Jump up ^ Jarvis, C. ( 2008 ). Physical Examination and Health Assessment. 5th edn. Saunders Elsevier, St Louis Jump up ^ Reuben, A. ( 2016 ). Examination of the abdomen. Clinical Liver Disease, 7 ( 6 ), 143 -- 150. doi : 10.1002 / cld. 556 Jump up ^ Felder, S., Margel, D., Murrell, Z., & Fleshner, P. ( 2014 ). Usefulness of Bowel Sound Auscultation : A Prospective Evaluation. Journal of Surgical Education, 71 ( 5 ), 768 -- 773. doi : 10.1016 / j. jsurg. 2014.02. 003 Jump up ^ Massey RL. Return of bowel sounds indicating an end of postoperative ileus : is it time to cease this long - standing nursing tradition ? Medsurg Nurs. 2012 ; 21 ( 3 ) : 146 -- 150 External links Abdominal exam -- a practical guide to clinical medicine from the University of California, San Diego. hide Medical examination and history taking Medical history Chief complaint History of the present illness Systems review Nursing assessment Allergies Medications Past medical history Family history Social history Psychiatric history Progress notes Mnemonics SAMPLE OPQRST SOAP COASTMAP Physical examination General / IPPA Inspection Auscultation Palpation Percussion Vital signs Temperature Heart rate Blood pressure Respiratory rate HEENT Oral mucosa TM Eyes ( Ophthalmoscopy, Swinging - flashlight test ) Hearing ( Weber, Rinne ) Respiratory Respiratory sounds Cyanosis Clubbing Cardiovascular Precordial examination Peripheral vascular examination Heart sounds Other Jugular venous pressure Abdominojugular test Carotid bruit Ankle - brachial pressure index Abdominal Digestive Liver span Rectal Murphy 's sign Bowel sounds Urinary Murphy 's punch sign Extremities / Joint Back ( Straight leg raise ) Knee ( McMurray test ) Hip Wrist ( Tinel sign, Phalen maneuver ) Shoulder ( Adson 's sign ) GALS screen Neurological Mental state Mini -- mental state examination Cranial nerve examination Upper limb neurological examination Neonatal Apgar score Ballard Maturational Assessment Gynecological Well - woman examination Vaginal examination Breast examination Cervical motion tenderness Assessment and plan Medical diagnosis Differential diagnosis Retrieved from `` https://en.wikipedia.org/w/index.php?title=Abdominal_examination&oldid=856291465 '' Categories : Diagnostic gastroenterology Physical examination Hidden categories : Articles needing additional references from January 2008 All articles needing additional references Wikipedia articles that are too technical from February 2012 All articles that are too technical Articles needing expert attention from February 2012 All articles needing expert attention Articles with multiple maintenance issues Talk Contents About Wikipedia Add links This page was last edited on 24 August 2018, at 05 : 34 ( UTC ). 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Question: when should you examine the areas of pain when physically assessing the patients abdomen
Answer: palpation