Abdominal Palpation

Palpation of Abdomen

Gentle/ superficial palpation:Z

• Start away from the area of pain, ask patient where is pain prior to examination.

Deep palpation:

• Deep tenderness-

• Guarding: muscle contracted overlying

• the tender area (acute inflammation)

• Mc Burney’s point,

Abdominal signs:

• Rebound/ Rovsing’s
• Murphy’s; deep palpation while taking deep breath, due to intraabdominal pressure
• Obturator
• Psoas; e.g. Abscess
• Organomegaly: liver , spleen, kidneys
• Other masses- abdominal wall or intra-abdominal
• Define all features of a mass: site, size, surface, borders, tenderness, pulsation, mobility
• Cough impulse

superficial palpation:

hair distribution, scars, respiratory problems, ask patient to cough to check positive cough impulse, check for any bulging mass prior to entering palpation

1. Cover all nine regions by palpation, ask patients in process if theres any pain
2. iliac fossa, lumbar, epigastrium, hypogastrium, etc…
3. Focus on patient face if theres any pain, look for any superficial mass or tenderness in process -
4. comment your findings; soft, no superficial palpable mass, tenderness, rigidity.
5. ask patient to flex knee to relax abdominal muscles, to differentiate between rigity or fear from examination.

Deep palpation: by All nine regions

Hepatomegaly;

1. RT. vertical-horizontal - starting from RT. iliac fossa, to RT. hypochondrium
2. ask patient to take deep breath, for deep palpation - to identify organ easily
3. comment; no enlarged, tenderness, deep tendon mass, any mass

Spleenomegaly -

1. right iliac fossa - crossing midline to left hypochondrium
2. ask patient to move right side, take deep breath for spleen to be easily assessed

for pyelonephritis -bimanual examination

1. costrophrenic angle one hand, other on abdomen on both sides
2. Percussion
3. comment on mass/tenderness

Masses of Abdomen

Mass in RUQ:

• Ca. hepatic flexure, enlarged gallbladder, enlarged right kidney, hepatomegaly

Mass in epigastric region:

• Liver, gastric carcinoma, abdominal aortic aneurysm (Palliation)

Mass in LUQ:

• Splenomegaly, carcinoma descending colon, swelling in tail of pancreas,
• Enlarged left kidney

Mass in periumbilical region:

• PUH, ca. transverse colon, tumour deposit (Sister Mary Joseph’s nodule)

Mass in LLQ:

• Descending colon (Benign, malignant Carcinoma) Sigmorectal

Mass in the suprapubic region:

• Distended urinary bladder, pregnancy, ovarian mass

Mass in RLQ:

• Appendiceal disease, ca. ascending colon, Crohn’s disease of ileo-caecal area

Mass in inguinal region:

• Hernia, lymphadenopathy, aneurysm

Examination for Kidney Enlargement