What are the protocols to do the examination of abdomen? A blog discussing the whole procedure of examination of abdomen

Generally the examination of the abdomen is done I’m following four steps
• Inspection
• Palpation
• Percussion
• Auscultation

How to do inspection of the abdomen of a patient?
While examining a patient’s abdomen, the following protocols must be practised.
1)Approach from the right side
2)Introduction and consent
3)Proper exposure
4)Position of the patient
5)Inspection
6)Cover the patient
7)Thank the patient
8)Present your findings to the examiner

Approach from the right side
While doing physical examination of patient, always approach the patient from right side.
Introduction and consent
It is essential to introduce yourself to the patient and take consent. Also, explain the procedure to the patient.
Proper exposure
To carry out a successful examination, proper exposure is essential. Expose the abdomen of the patient from the lower end of the sternum to the public symphysis.
Position of the patient
Part of the patient should be supine, lying on the bed with arms alongside the body.
Inspection
Inspect the abdomen of the patient at the following positions.
While standing on the right side
By coming to the level of the abdomen if the patient
From the feet side of the patient.
Ask the patient to cough to look for any hernial orifices

The inspection involves simply looking at the patient’s abdomen for
• The shape of the abdomen (may be scaphoid or distended)
• The shape of the umbilical if it is everted or inverted. Typically the umbilicus is inverted
Position of the umbilicus if it is central or not
• Any Scars (maybe present of any surgery has been done in the past)
• Any Striae (white or pink strive may be present in case of a recent change in the size of the abdomen, for example, in pregnancy or treated ascites)
• Abnormal pigmentation
• Peristaltic movements
• Look for symmetrical respiratory movements on both sides of the umbilical
• Any visible pulsations
• Any visible veins (may be present in obstruction of inferior vena cava)
• Normal distribution of hair (may be absent in males n liver cirrhosis.
• Look if any hernial orifice is present
Cover the patient
The area uncovered while the inspection should be covered carefully.
Thank the patient
Thank the patient for his cooperation before presenting the examination to your examiner.

Present your findings to the examiner
Explain your findings to the examiner.

How to present the examination of abdomen in front of an examiner?

In the case of the typical abdomen, it can be presented as:
On inspection, the abdomen is normal and moves symmetrically with respiratory movements. The umbilicus is central and inverted. There are no visible scars, striae, peristalsis, visible veins, pulsations or pigmentation. Hair distribution is normal. Hernial orifices are intact.
Palpation of the abdomen
Palpation of the abdomen is done in the following three steps
• Superficial palpation
• Deep palpation
• Visceral palpation
Repeat the protocols discussed above for the inspection of the abdomen. Also, ask the patient if he feels pain in any part of the abdomen. Inspect that part of the abdomen at last.

Superficial palpation
It is done to
• Gain the confidence of the patient
• To look for any tenderness, mass or muscle rigidity. If any viscera is inflamed, the muscle above the viscera becomes rigid. For example, appendicitis. The whole abdomen becomes rigid in case of diffuse peritonitis. This is called board-like rigidity.
How to do superficial palpation of the abdomen?
The abdomen is palpated gently, starting from the left iliac fossa, left lumbar region, left hypochondrium, epigastrium, umbilical region, hypogastrium, right iliac fossa, right lumbar region and right hypochondrium.
Deep palpation of the abdomen
Deep palpation is done to look for:
• Any mass
• Tenderness
• Rebound tenderness
How to do deep palpation of the abdomen?
The sequence is the same as discussed above. Place your hand over the abdomen moulded to the shape of the abdomen. Keep looking at the face of the patient for any grimacing if tenderness is present.

Visceral palpation
The following viscera are commonly palpated while physically examining the abdomen.
• Liver
• Spleen
• Kidneys
Palpation of liver
To palate the liver, place your right hand vertically over the right iliac fossa, with the fingers facing towards the right costal margin. Press the hand inwards during expiration and keep it steady during explanation. It is the most commonly used method.
Another classic method is also used. Place your right hand over the right iliac fossa parallel to the right costal margin with your index finger facing the right costal margin. Palpate the lower border of the liver.
To know the limit of the upper border of the liver, percussion is done.
If enlarged, the liver can reach the right iliac fossa.
Causes of liver enlargement
Hepatomegaly is the term used for the enlargement of the liver. Its causes are
Portal hypertension
• Early cirrhosis
• Acute Viral hepatitis
• Chronic active hepatitis
• Right heart failure
• Lymphomas
• Leukemias
• Amebic liver access
• Enteric fever
• Malignancy fever
• Fatty Liver disease
Palpation of spleen
Place your hand over the right iliac fossa with the fingers facing towards the left costal margin. Palpate the spleen.
The other method is to place your left hand over the left lower ribs posteriorly and apply pressure. Use your right hand to palpate the spleen over the left costal margin from the medial to the lateral side.
The spleen enlarges towards the right iliac fossa. The causes of spleen enlargement are :
• Malaria
• Enteric fever
• Viral hepatitis
• Lymphomas
• Leukemias
• Systemic lupus erythematosus
• Miliary Tuberculosis
• Myelofibrosis
• Subacute endocarditis
• Infectious mononucleosis
• Portal hypertension
• Hemolytic anaemia
• Cirrhosis of liver

Palpation of kidneys
Put your left hand over the right lumbar region posteriorly and your right hand anteriorly at the same level. Apply forward pressure with the left hand and place the right kidney with the right hand. Repeat the same procedure on the left side.

Percussion of the upper border of the liver
Find the right second intercostal space and percuss the space by placing the middle phalanx of the middle finger of the left hand over the space and tapping it with the middle finger of the right hand. The movement should be on the wrist joint and not on the elbow joint. Usually impaired note is felt at the fourth or fifth to intercostal space where the upper border of the liver is present.
Auscultation
Bowel sounds are heard on the right side of the umbilicus. They will be heard after every 5-10 seconds. They are felt due to peristalsis.
Conclusion
That’s all about the examination of the abdomen. It is essential to examine the patient’s abdomen to diagnose the disease.