ABDOMINAL EXAMINATION

M.THAMRIN TANJUNG
 Abdominal examination
empty her bladder before the abdominal
examination.
lying semi-recumbent, with a sheet
covering her
 It is usual to examine the woman from her
right-hand side.
Abdominal examination comprises
inspection, palpation, percussion and
appropriate,auscultation.
 Inspection
The contour of the abdomen should be inspected and
noted.
There may be an obvious distension or mas
The presence of surgical scars, dilated veins or
striae gravidarum (stretch marks) should be noted.
It is important specifically to examine the umbilicus for
laparoscopy scars and just above the symphysis pubis
for Pfannenstiel scars (used for Caesarean section,
hysterectomy, etc.).
The patient should be asked to raise her head or cough
and any herniae or divarication of the rectus muscles
will be evident.
 Palpation
First, if the patient has any abdominal pain, she
should be asked to point to the site. This area
should
not be examined until the end of palpation.
It is usual to get the patient to cough, as she
may show signs of peritonism.
Palpation using the right hand is performed,
examining the left lower quadrant and
proceeding in a total of four steps to the right
lower quadrant of the abdomen.
 Palpation
Palpation should include examination for
masses, liver, spleen and kidneys.
If a mass is present but it is possible to palpate
below it, it is more likely to be an abdominal
mass rather than a
pelvic mass.
It is important to remember that one of the
characteristics of a pelvic mass is that one
cannot
palpate below it.
 Palpation
If the patient has pain, her abdomen
should be palpated gently and the
examiner should look for signs of
peritonism, i.e. guarding and rebound
tenderness.
The patient should also be examined for
inguinal herniae and lymph nodes.
 Percussion
Percussion is particularly useful if free fluid is suspected.
In the recumbent position, ascitic fluid will settle down
into a horseshoe shape and dullness in the flanks can be
demonstrated.
As the patient moves over to her side, the dullness
will move to her lowermost side; this is known as
'shifting dullness'. A fluid thrill can also be elicited.
An enlarged bladder due to urinary retention will also be
dull to percussion and this should be demonstrated to
the examiner (many pelvic masses have disappeared
after catheterization
 Auscultation

This method is not specifically useful for

the gynaecological examination. However,
a patient will sometimes present with an
acute abdomen with bowel obstruction
or a postoperative patient with ileus, and
therefore listening for bowel sounds may
be appropriate.