Abdominal examination is divided into inspection, palpation, percussion and auscultation.
Inspection: In order to inspect a patient, we need to expose the patient below nipple to mid of thighs, but since dignity of patient is very important in present era, so we can perform examination of genitals after completing full examination with in few minutes, but never skip genital examinations as well as per rectum examination.
First of all look for shape and size of abdomen, normally it should be flat, abdomen is globular in case of five F’s (fat, fluid, foetus, flatus and faeces).
See for the movements with respiration, in males abdominal breathing is present, generally all quadrants move equal with respiration, movements are absent in case of generalized peritonitis.
Look for bilateral symmetry of abdomen, it is lost in case of some tumor, If you see pear shaped swelling above pubic symphysis it may be due to distended bladder.
Normally umbilicus is retracted and inverted, however it is transversly stretched in ascitis ( also known as laughing umbilicus ), it is everted in case of umbilical hernia and increased extra abdominal pressure.
Look for dilated superficial veins on abdomen, when they are present around umbilicus condition is known as Caput Medusae, seen in portal hypertension and cirrhosis.
Visible peristalsis is seen in case of intestinal obstruction and visible pulsations are seen in thin patients due to pulsations of abdominal aorta.
Linea nigra and linea alba is seen in case of pregnant female.
See for scar marks of trauma, surgery, skin hyper or hypo pigmentation.
Watch the video of how to do inspection and palpation of abdomen below on you tube video
Palpation: just palpate whole of abdomen so as to know whether abdomen is tender or not, feel its rigidity, consistency, normal abdomen is elastic in consistency however it is doughy in case of tuberculosis of abdomen.
Feel for any abnormal mass, temperature of skin by back of hand, see for organomegalies like hepatomegaly, spleenomegaly, enlarged kidneys as explained in video in this post.
If liver is enlarged, you must look for its surface, margins, consistency, tenderness and lower border.
Genitals should be examined, look for both testis, penis, per rectum examination must be done, in case of females, pervaginum examination must be performed, all hernial sites must be observed carefully.
We forget to tell you that you must see the filling of dilated veins over abdomen, how they are getting filled and in which direction.
Percussion: we must percuss abdomen to find out free fluid present in it, in order to find out free fluid it is percussed in 3 way depending upon the amount of fluid present in abdomen.
Fluid thrill( when fluid is more than 1500ml), Shifting dullness(fluid is around 1500ml) and puddle sign ( when fluid is less than 500 ml).
Shifting dull is performed as shown in video by Dr Vikram Singh Yadav, for puddle sign and fluid thrill video will be added later on.
Calculate the liver span by looking upper and lower border and measuring the distance by inch tape.
Ausculataion: Ausculate the abdomen in right iliac fossa for abdominal sounds, normally they are three to four in number in one minute, increased in diarrhea and absent in silent abdomen.
Watch out video on how to palpate kidney and perform shifting dullness test below on you tube video