1. Introduction
The abdominal examination is a core clinical skill used to assess gastrointestinal, hepatobiliary, urological and vascular pathology. A consistent sequence helps you identify key findings and avoids missing important signs.
2. Preparation and general inspection
Wash your hands, introduce yourself, confirm the patient''s identity and explain the examination. Ask about abdominal pain and request that the patient tells you if anything is uncomfortable. Position the patient supine with one pillow, arms by their sides and expose from the xiphisternum to the pubic symphysis while maintaining dignity. Inspect from the end of the bed for pain, distress, jaundice, cachexia, hydration, drains, catheters, stomas or abdominal distension.
3. Hands, face and chest
Inspect the hands for clubbing, leukonychia, koilonychia, palmar erythema, Dupuytren''s contracture, bruising and asterixis. Check the pulse. Inspect the face for conjunctival pallor, scleral icterus, xanthelasma, corneal arcus, parotid enlargement and oral ulceration. Inspect the chest for spider naevi, gynaecomastia and scars.
4. Abdominal inspection
Inspect the abdomen tangentially and directly for contour, distension, asymmetry, scars, striae, dilated veins, rashes, bruising, hernias, visible masses, visible peristalsis and pulsations. Ask the patient to cough if assessing for a hernia.
5. Palpation
Begin with light palpation away from pain, assessing for tenderness, guarding and masses in all nine regions. Progress to deep palpation. Palpate specifically for the liver, spleen, kidneys and abdominal aorta. If peritonism is suspected, assess for percussion tenderness and use rebound tenderness only if clinically appropriate.
6. Percussion and auscultation
Percuss all nine regions for tympany or dullness. Assess liver span if relevant, percuss for splenic enlargement and test for shifting dullness if ascites is suspected. Auscultate for bowel sounds and listen for bruits over the aorta and renal arteries when indicated.
7. Completion
To complete the examination, assess for sacral oedema, examine the external genitalia and hernial orifices if relevant, and perform a digital rectal examination if indicated. Summarise the findings and suggest appropriate bedside tests, blood tests and imaging.
Preparation
General inspection
Hands
Face
Chest
Inspection
Palpation
Percussion
Auscultation
Completion