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Abdominal Examination

Anatomic Landmarks

Xiphoid process to symphysis pubis

Inguinal ligaments

Anterior superior iliac spines

Costal margins


11th and 12th ribs

Costovertebral angle


Mid-axillary and mid-clavicular lines

Proper Positioning

Supine, flat on table - insert hand under back to check

Arms at sides or folded across chest not overhead

Before exam, have patient point to areas of pain

Monitor exam by watching patients face for signs of discomfort

Examine from right side (systematic, traditional, etc.)

Inspection-Auscultation-Percussion-Palpation is the proper order for an abdominal exam.


Skin note scars, striae, dilated veins, rashes and lesions.

Umbilicus contour, location, any inflammation or bulges.

Contour of the abdomen symmetry, is the abdomen flat, rounded, protuberant, or scaphoi
(markedly concave or hollowed)?

Are there visible organs or masses? Look for an enlarged liver or spleen that has descende
below the rib cage.

Bulging flanks - ascites.

Pulsations normal aortic pulsation is frequently visible in the epigastrum, RV, liver, other.

Auscultation - Listen for abdominal sounds with the diaphragm of the stethoscope in all four
abdominal quadrants before any palpation or percussion. Normal sounds consist of clicks and
gurgles, approximately 3 34 times per minute.

Auscultation for abdominal bruits (over the aorta, illiac arteries and the femoral arteries).


Assess amount and distribution of gas, identify masses (tympany vs. dullness)


Assess size of liver and spleen

Traubes space left costal margin, mid-axillary line, 6 th ICS

Shifting dullness

Percuss the abdomen in all four quadrants (at least these 4 locations, more if there is a problem).
Can go from top to bottom or bottom to top. Will mostly hear tympany, but will hear dullness from
fluid and feces.
Percussion of the liver span:
Start at a level below the umbilicus (in an
area of tympany, not dullness). Lightly
percuss upward toward the liver. Ascertain
the lower border of the liver dullness in the
midclavicular line. Next, identify the upper
border of liver dullness in the midclavicular
line. Lightly percuss from lung resonance
down toward liver dullness. Now measure in
centimeters the distance between the two
points the vertical span of liver dullness.
(4-8 cm in midsternal line, 6-12 cm in right
midclavicular line).

Percussion of Traubes Space: (two techniques for detecting splenomegaly). See arrows for
suggested routes of percussing the spleen.


Palpate areas of pain last

Observe face of patient for signs of discomfort

Cycle of light palpation followed by deep

Check for rebound tenderness



Light Palpation

Deep Palpation

Palpation of the liver

Special Tests:

Scratch Test
Shifting Dullness
Fluid Wave
Rovsings Sign
Psoas Maneuver
Obturator Sign
Murphys Sign
Assessing for Possible Ascites

Palpation of the spleen

Assessing for Shifting Dullness

Assessing for a Fluid Wave