Physical Exam of the Abdomen

GENERAL INSPECTION (Initially position pt at 45 degrees & expose

Axilla
Bladder
waist up)

Lymphadenopathy (malignancy, infection)

Palpable bladder urinary retention

Appearance (respiratory distress, in pain, confused, agitated,

Hair loss (malnourishment, iron deficiency anemia)

PERCUSSION
ascites)

Acanthosis nigricans (GI malignancy, obesity)

Abdominal organs

Body habitus (cachectic, low BMI, normal weight, obese)

Neck
Liver percuss from RIF upwards to check size of liver

Scars (midline (laparotomy), RIF (appendectomy), right subcostal

Cervical lymph nodes (infection, malignancy)

Spleen percuss from RIF towards left hypochondrium
(cholecystectomy)

Virchows node (gastric malignancy)

Bladder percuss suprapubic region

Jaundice (cirrhosis, hepatitis)

Raised JVP (SVC obstruction, hepatovenous obstruction)

Shifting dullness

Anemia (GI bleeding)

Chest
Percuss from center to flank until dullness is noted, keep

Abdominal distention (ascites, bowel distention, large masses,

finger at the spot and ask pt. to roll over to opposite side.

Spider nevi (chronic liver disease)

obesity, pregnancy, gas)
Keep pt. on their side for 30 secs. Repeat percussion, if fluid

Gynecomastia
(liver
cirrhosis,
drug
side
effects)

Bulges (malignancy, organomegaly)

was present in the area before, it should now be resonant

Hair
loss
(malnourishment,
iron
deficiency
anemia)

Dressings (wounds infection, bleeding)

Abdomen
Eye

Masses (organomegaly, malignancy)

Jaundice (hemolysis, hepatitis, cirrhosis, biliary obstruction)

Pulsation (central abdominal aortic aneurysm)

Conjunctival pallor (anemia)

Cullens & Grey-Turners sign (pancreatitis, abdominal aortic

Xanthelsema (hyperlipidemia)
aneurysm)

Kayser-Fleisher ring (Wilson's disease)

Striae (abdominal distention)

Mouth

Caput medusae (portal hypertension)

Angular stomatitis (iron, vitamin B12 deficiency)

Stomas (colostomy ILF, ileostomy RIF, urostomy RIF & contains

Angular cheilitis (iron deficiency)

urine)

Poor dentition, gingivitis (scurvy)

AUSCULTATION

Glossitis (iron, folate deficiency)

Bowel sounds - Normal (gurgling); abnormal (tinkling (high pitch)

Oral candidiasis (iron deficiency, immunodeficiency)

bowel obstruction); absent (ileus/peritonitis)

Apthous ulcers (Crohn's disease, celiac disease)

Bruits aortic bruits just above umbilicus (AAA); renal bruits just
Hand
above umbilicus, lateral to midline. Mickey mouse sign

Skin color (brown hemochromatosis, yellow jaundice, tar stain

PALPATION (Ask about areas of pain & examine these last; watch
smoker)
pt.'s face throughout)

Temperature (cold Raynaud's, scleroderma)

Light palpation palpate the 9 abdominal regions and assess for
tenderness, rebound tenderness (peritonitis), guarding (local or

Clubbing (IBD, cirrhosis, celiac disease)

generalized), masses

Koilonychia (iron deficiency)

Deep palpation palpate the 9 abdominal regions for masses. Assess

Leukonychia (hypoalbuminemia, liver failure, entropathy)

location, size, shape, consistency (smooth, rough, soft, hard,

Palmar erythema (liver disease, pregnancy)

irregular), mobility, pulsatility (vascular etiology)

Dupuytrens contracture (alcoholism)

Liver start palpation in right iliac fossa. When you feel the liver

Tremor (delirium tremens)

edge, note degree of extension below costal margin, consistency of

Asterixis (hepatic encephalopathy, uremia, CO2 retention)

liver edge, tenderness (hepatitis), pulsatility (tricuspid regurgitation)
Arm

Gall bladder usually not palpable. Enlarged gall bladder

Bruising and petechiae (coagulation disorder, liver failure, low

(cholecystitis). Perform palpation at right costal margin, midplatelets)
clavicular line (9th rib). If enlarged, a large mass that moves with
respiration may be noted. Check for Murphys sign (cholecystitis)

Needle tracks (hepatitis, HIV)