Abdominal examination assesses the abdomen.

• Ensure stomach has adequate exposure
• Nails:
  • Leukonychia, of hypoalbuminemia of liver disease
  • Koilonychia, of iron deficiency anemia
  • Clubbing, via Schamroth’s window test, of liver disease
• Palm:
  • Palmar erythema, of liver disease
  • Palmar crease pallor, of anemia
  • Dupuytren’s contracture, of alcoholism
  • Liver flap, of hepatic encephalopathy
• Wrist:
  • Elevated pulse, of sepsis
• Arm:
  • Track marks, of IV drug usage
• In the eye:
  • Arcus senilis, a white/gray/blue ring encircling the iris, of hypercholesterolemia
  • Kayser-Fleischer rings, dark rings encircling the iris, of Wilson's disease
  • Jaundice, yellowish coloration of the sclera, of hyperbilirubinemia, of liver disease. Yellow discoloration of skin that doesn’t include the sclera could be due to carotenemia (i.e. a harmless condition, due to excessive intake of carrots)
  • Conjunctival pallor, of anemia
  • Xanthelasma, of hypercholesterolemia
• In the mouth:
  • Buccal mucosa ulcers, of Crohn's disease
  • Red and fat tongue, of anemia
• In the neck:
  • Lymphadenopathy, asking the patient to clench teeth, and feel-
  • Supraclavicular lymph nodes, which drains the thoracic duct, which drains the entire abdomen and the left thorax
• General inspection, including observing for:
  • Conscious level, of hepatic encephalopathy
  • Hydration, weight, and other nutritional information
  • Spider nevi, especially >5, of hyperestrogenemia, of liver disease
  • Gynecomastia, of hyperestrogenemia, of liver disease

Abdomen, including-

• Inspection:
  • Request patient to breath in and out, and cough, to look for hernia
  • No abdominal distension, of the 6 F’s– fat, feces, fetus, flatulence, fluid (ascites), a filthy big tumor
• Auscultation: Done first because of the impact of subsequent tests on auscultation
  • Of all 9 quadrants, including growling sounds (of bowel obstruction), absence of sounds (of peritonitis)

Source: 2013/03/nine-abdominal-regions-or-areas.jpg">Healthfixit

RLQ is an abbreviation of Right Lower Quadrant. RUQ is an abbreviation of Right Upper Quadrant

• Palpation, asking first about pain, which should be last to be touched or guarding may make the examination difficult:
  • First lighter palpation (singer hand), then deeper (double hand), in all 9 areas, starting from lower RHS, moving in clockwise direction, and then central. Looking at the Pt's face, but examining for:
    • Tenderness
    • Rebound tenderness (tender when pressure is removed, of peritonitis)
    • Guarding (of inflammed organs)
  • Organ palpation, for organomegaly, including of the:
    • Usually hidden:
      • Liver (from lower RHS to upper RHS, underneath the RHS costal margin; on in-breath)
      • Spleen (from lower RHS to upper LHS, underneath the LHS costal margin; on in-breath)
    • Ever present:
      • Kidneys (putting hand on top down, and flapping other hand up)
  • Can also palpate the abdominal aorta for expansion, of aneurysm
• Percussion, from resonant to dull, starting from the stomach and moving upwards. Percuss hard for deeper structures, to soft for superficial structures. Percuss ribs between ribs. And testing for ascites, including:
  • Shifting dullness, testing for ascites. Starting at umbilicus, percussing down. Then, turn the patient around to the side just percussed down, and see if the same region (that was dull) is now resonant. If it is, there is ascites
  • Or alternative test, fluid test, which involves putting their hands together in clap position, down tummy line. One side is hit, and the other side felt (simultaneously) for fluid
• To complete the exam:
  • Examination of genitalia
  • Rectal examination
  • Urinalysis

A picture of an elongated hexaogan represents an abdomen, no scribbles on it indicates no abnormally large organs, no surgical scars and no masses felt.

• Tenderness
• Bowel movement