A site for medical students - Practical,Theory,Osce Notes

Inspection of abdomen

Patient should lie flat with one pillow under the head and the abdomen is exposed from the xiphisternum to the pubic symphysis.
Start inspecting the abdomen and note the following features.
Shape of abdomen
Normal shape of abdomen is scaphoid in supine position, moves freely with respiration in vertical direction. No visible mass, no visible peristalsis except in thin individual.

Causes of scaphoid (sunken) abdomen :
  1. Severe dehydration.
  2. Emaciation or cachexia.
  3. Starvation.
  4. Tuberculous peritonitis.
  5. Malignant peritonitis.
  6. Meningitis.
Skin over the abdomen
Distension of abdomen
Dilated vein over the abdomen 
Examination of umbilicus 

Pulsations of the abdomen
Visible pulsation of abdominal aorta is noted in thin persons.
Epigastric pulsation  are noticed in
  1. Aortic aneurysm.
  2. Right ventricular enlargement
  3. Vascular tumors of the liver.
Movement of abdominal wall
To surprise the patient and to impress the examiners, squat down beside the bed so that the patient's abdomen is at eye level.
Ask him to take slowly take deep breaths through the mouth and watch for the movement of the abdomen.
Normally - Gentle rise in inspiration and fall in expiration
Markedly decreased or absent in peritonitis still silent abdomen.

Scar over the abdomen
  1. Old scar - White in colour
  2. Recent scar are Pink due to the presence of vascularity
Hair over the abdomen
  1. Secondary sexual hair - Seen in male after puberty and adults
  2. Absence of  secondary sexual hair - Indicates hypogonadism
  3. Presence of secondary sexual hair - Above inguinal line in female indicate virilising tumors.
Pigmentation of scar seen in Addison's disease.