1. Inspection:
- General Appearance: Begin by observing the patient's overall appearance, noting their posture, facial expressions, and any signs of discomfort or distress. Assessing the patient's general demeanor can provide valuable initial insights into their health status.
- Abdominal Contour: Evaluate the shape and contour of the abdomen. Note whether it appears flat, rounded, or distended. Abnormalities such as asymmetry or bulging may indicate underlying pathology such as organ enlargement or mass effect.
- Skin: Examine the skin of the abdomen for any abnormalities such as rashes, lesions, discoloration, or visible veins. Pay particular attention to signs of jaundice, which manifest as yellowing of the skin and sclerae and may indicate liver dysfunction.
- Scars: Look for any surgical scars or evidence of trauma on the abdomen, as these may provide clues to the patient's medical history and previous interventions.
2. Palpation:
- Light Palpation: Begin palpation with gentle pressure, using the pads of your fingers to assess for tenderness, muscle tone, and surface abnormalities. This technique helps to identify superficial masses, tenderness, and areas of guarding.
- Deep Palpation: Apply firmer pressure to palpate deeper structures such as organs and deeper masses. Palpate systematically in all four quadrants of the abdomen, assessing for organ enlargement, masses, or areas of tenderness. Note any palpable abnormalities such as hepatomegaly (enlarged liver) or splenomegaly (enlarged spleen).
- Organ Borders: Pay attention to the borders of palpable organs such as the liver and spleen, noting any irregularities or changes in consistency. A smooth liver edge is characteristic of a healthy liver, whereas a firm, irregular edge may indicate pathology such as cirrhosis or malignancy.
- Rebound Tenderness: Assess for rebound tenderness by palpating deeply in a specific area and then quickly releasing pressure. Presence of rebound tenderness, where the patient experiences increased pain upon release of pressure, may indicate peritoneal irritation and inflammation.
3. Percussion:
- Tapping Technique: Use percussion to assess the density of underlying structures by tapping the abdomen with your fingertips. Percuss in all quadrants of the abdomen, comparing the sounds produced.
- Dullness vs. Resonance: Dullness on percussion may indicate the presence of solid organs, fluid accumulation (e.g., ascites), or masses. Resonance is the expected sound over gas-filled structures such as the stomach and intestines.
- Shifting Dullness: Perform percussion while changing the patient's position (e.g., from supine to lateral decubitus). Shifting dullness occurs when fluid within the abdomen (e.g., ascites) moves with gravity, causing dullness to shift to the dependent side.
- Liver Span: Assess liver span by percussing from resonance (lung) to dullness (liver). The normal liver span is approximately 6-12 cm in the midclavicular line, although this can vary based on factors such as body habitus.
4. Auscultation:
- Bowel Sounds: Use a stethoscope to auscultate bowel sounds in all four quadrants of the abdomen. Normal bowel sounds are characterized by rhythmic, gurgling noises occurring every 5 to 15 seconds. Absent bowel sounds may indicate ileus or bowel obstruction, while hyperactive sounds may indicate diarrhea or gastroenteritis.
- Vascular Sounds: Listen for vascular sounds such as bruits over major arteries including the aorta, renal arteries, and iliac arteries. Bruits are abnormal sounds caused by turbulent blood flow and may indicate arterial stenosis or aneurysm.
- Friction Rubs: Auscultate for friction rubs, which are grating or scratching sounds caused by inflammation of the peritoneal or pleural surfaces. Friction rubs may indicate conditions such as peritonitis or pleuritis.
