An abdominal examination is a portion of the physical examination which a physician or nurse uses to clinically observe the abdomen of a patient for signs of disease. The abdominal examination is conventionally split into four different stages: first, inspection of the patient and the visible characteristics of their abdomen. Auscultation (listening) of the abdomen with a stethoscope. Palpation of the patient's abdomen. Finally, percussion (tapping) of the patient's abdomen and abdominal organs. Depending on the need to test for specific diseases such as ascites, special tests may be performed as a part of the physical examination. An abdominal examination may be performed because the physician suspects a disease of the organs inside the abdominal cavity (including the liver, spleen, large or small intestines), or simply as a part of a complete physical examination for other conditions. In a complete physical examination, the abdominal exam classically follows the respiratory examination and cardiovascular examination. and the Rational Clinical Examination refute this.
Inspection
The doctor will look at the movement of the abdomen checking specifically for waves or odd flexing.
Auscultation
Auscultation refers to the use of a stethoscope by the examiner to listen to sounds from the abdomen.
Unlike other physical exams, auscultation is performed prior to percussion or palpation, as both of these could alter the regularity of bowel sounds. and intestinal contractions can be silent. Hyperactive bowel sounds may be caused by partial or complete bowel obstruction as the intestines initially try to clear the obstruction. Absence of sounds may be caused by peritonitis, paralytic ileus, late-stage 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 abnormal blood flow sounds (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
The examiner should first talk to the patient and explain what this part of the examination will involve. These include
- Inflamed gallbladder: Murphy's sign
- During palpation beneath the bottom edge of the right rib cage, the patient experiences pain upon inspiration.
- Appendicitis or peritonitis:
- Psoas sign – pain with extension of the hip and tensing of the psoas muscle
- Obturator sign – pain when tensing the obturator muscle