Abdominal Examination [Complete]

Question 1

Please perform light palpation of the nine abdominal regions and name each region that is being palpated.

Answer 1

“Im now going to have a feel around the abdomen. Before I start have you been experiencing any pain at all?”

Lightly palpate with one hand, starting at the left iliac region (L iliac, L lumbar, L hypochondriac, Epigastric, umbilical, suprapubic(hypogastric), R iliac, R lumbar, R hypochondriac)

ALWAYS LOOK FOR FACIAL EXPRESSION

Question 2

Please perform deep palpation of the nine abdominal regions and name each region.

Answer 2

“I am now going to press a little harder this time, please let me know if you feel any discomfort”

Same as light palpation but use two hands

Question 3

Please palpate the liver

Answer 3

“Im now going to ask for you to take deep breath in and out for me”

Begin palpation in the right iliac fossa, starting at the edge of the superior iliac spine, using the flat edge of your hand (the radial side of your right index finger)

Should feel for it during inspiration (move hand to next position after expiration has fully occured)

Repeat this process of palpation moving 1-2 cm superiorly from the right iliac fossa each time towards the right costal margin.

Question 4

Please palpate the gallbladder

Answer 4

“Please take a deep breath in and out for me please let me know if you experience any pain”

Palpate at the right costal margin at the mid-clavicular line.

(Observe for if they catch their breath upon deep insipiration)

Question 5

Please palpate the spleen

Answer 5

“Could you please take a deep breath in and out for me?”

Feel starting at right iliac fossa (starting at ASIS) move up and along following the left costal margin

Question 6

Please ballot the kidneys

Answer 6

Place your left hand behind the patient’s back, below the ribs and underneath the right flank.

Then place your right hand on the anterior abdominal wall just below the right costal margin in the right flank. (place fingers in costrophrenic angle which is angle of 12th rib to posterior median line)

Push your fingers together, pressing upwards with your left hand and downwards with your right hand.

Ask the patient to take a deep breath in and out

Question 7

Please palpate the aorta

Answer 7

1. Using both hands perform deep palpation just superior and to the left of the umbilicus in the midline.
2. Note the movement of your fingers (also make sure the pinky side of hand is following border of costal margin)

In healthy individuals, your hands should begin to move superiorly with each pulsation of the aorta.

If your hands move outwards, it suggests the presence of an expansile mass (e.g. abdominal aortic aneurysm).

Question 8

Please palpate the bladder

Answer 8

“Before I begin have you used the toilet recently?”

“This may feel slightly uncomfortable and you may feel the urge to pass urine”

palpate from top of suprapubic area to bottom region

Question 9

Please percuss the liver to determine the upper and lower borders

Answer 9

“I am now going to have a tap on the abdominal region”

Start in the right iliac fossa and stop percussing when you hear a change from resonant to dull (Usually at right costal margin)

Starting in the midclavicular line at about the 3rd intercostal space, lightly percuss and move down.

Percuss inferiorly until dullness denotes the liver’s upper border (usually at 5th intercostal space in MCL).

Average size: 6-12cm in midclavicular line (7cm in fem-10cm in males)

“The size of the liver from the midclavicular line is aproximately 6cm

13cm ACCORDING TO INSENDI

Question 10

Please percuss the spleen (Geeky medics method)

Answer 10

Percuss upwards 1-2 cm at a time from the right iliac fossa (the same position used to begin palpation) towards the left costal margin until the percussion note changes from resonant to dull indicating the location of the spleen (in the absence of splenomegaly the spleen should not be identifiable using percussion).

Question 11

Please percuss the spleen (insendi method)

Answer 11

Percuss in the intercostal space between the 10th and 11th rib at the left anterior axillary line

Question 12

Please assess for ascites and shifting dullness

Answer 12

Percuss starting from the abdominal region towards the left flank (with finger pointing towards the patient’s feet)

If ascites suspected ask person to turn towards you and lie to their side. Wait 30 seconds and percuss again (JUST TELL EXAMINER THAT UD USUALLY WAIT FOR 30 SECONDS)

Question 13

Please perform a fluid thrill test (for severe ascites)

Answer 13

“I am going to check to see if there is any fluid in your abdomen, this will involve me gently flicking the side of your abdomen”

place the palm of your left hand over the left side of patient’s abdomen and flick a finger of your right hand on the right side of the abdomen. If you feel a ripple against your left hand, a fluid thrill is present

Question 14

Please assess for the presence of bowel sounds

Answer 14

Listen for bowel sounds in at least 2 areas (Usually below umbillicus to the left and right)

(Need to listen for at least 3 minutes however just listen for 20-30 seconds).

Question 15

Please auscultate the abdominal aortic artery

Question 16

Please auscultate the renal arteries

Answer 16

2-3cm above the umbilicus laterally

Question 17

Please auscultate the superior mesenteric and coelic arteries

Answer 17

Auscultate in the umbilicus region

Question 18

Please asucultate for liver tumor

Answer 18

Mid-clavicular line at right costal margin

Question 19

Please auscultate for the iliac arteries

Answer 19

3cm below the umbillicus laterally on both sides