Abdominal Examination (Gastrointestinal Tract Examination) : Inspection, Palpation, Percussion, & Auscultation
Systemic examination of abdomen is as following:
A. Inspection
Shape of abdomen
Movements with respiration (Quadrants of abdomen)
Visible peristalsis
Skin or Surface of Abdomen
- Dilated or engorged veins (Part of abdomen, Direction of flow)
- Caput medusae
- Purple striae
- Striae atrophica or gravidarum
Hernial orifices
Divarication of recti
Measurements
- Abdominal girth
- Distance between lower end of xiphisternum to umbilicus and from umbilicus to symphysis pubis
Scrotum
B. Palpation
Superficial
- Tenderness
- Rigidity
Deep
Start in left iliac fossa palpating lightly and working anti-clockwise to end in suprapubic region. The order of palpation of organs are:
- Left kidney
- Spleen
- Right kidney
- Liver
- Urinary bladder
- Aorta and para-aortic glands and common iliac vessels
- Palpate both groins
- Examine external genitalia
Describe about size, surface, margins, consistency, tenderness.
C. Percussion
Organ percussion
- Liver
- Spleen
- Any other lump
Percussion for free fluid in abdomen
- Fluid thrill (This is felt when there is a large amount of fluid under tension, i.e. > 2000 ml)
- Shifting dullness (About 1000 ml of fluid should be present to elicit this sign)
- Horse-shoe shaped dullness
- Puddle sign (It can detect as little as 120 ml of ascitic fluid)
Percussion of Cyst
- Hydatid Thrill
D. Auscultation
What to observe?
Bowel sounds (peristaltic sounds)
Arterial bruit
Paraxiphoid venous hum
Friction rub (Hepatic/Splenic)
Succussion splash
