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

Points noted during superficial palpation of abdomen :

Prerequisites for abdominal palpation:
  • Warm your hands by rubbing specially in winter and trim your nails for satisfactory abdominal palpation. 
  • You should stand on the right side of the patient.
  • Use the flat of the right hand (don't poke with fingers)
  • Prepare the patient with thigh flexed, face turned to the opposite side. The patient is asked to
  • breathe quietly. 
  • Exposure oi abdomen is the same as done during palpation of liver.
  • Movements of the right hand should be gentle and come from slight flexion of metacarpophalangeal joint. The hand is held flat and moulded to the abdominal wall.
  • You should start  from leltiliacfossa and move anti-clockwise to end in suprapubic  and umbilical region
Points to note during palpation of abdomen:
Surface temperature.
  • Tenderness is suggestive of disease or inflammation of an underlying organ, provided abdominal wall is normal 
  • Rebound tenderness -Patients complain of sharp pain when pressure over a painful area is suddenly released. It signifies inflammation of not only the viscera but also of the parietal peritoneum is also there.
  • Shifting tenderness: It may’ be present in acute non-specific mesenteric adenitis.
  • Referred or crossed tenderness: When pressure is applied to one area of abdomen there is pain or tenderness in  another area. This is seen in acute appendicitis (Rovsing's sign)
Parietal oedema.
Consistency (normal feel, muscle guard or rigidity) link
Doughy feel of abdomen is diagnostic of tuberculous peritonitis. It may also be present in tropical sprue or in multiparous women.
Any localised lump.
Pulsation (transmitted or expansile).
Divarication of recti.
To determine the flow in prominent abdominal veins
Fluid thrill with girth of the abdomen at the level of the umbilicus.
Guarding –It is the  resistance to palpation due to reflex contraction of the abdominal wall muscles. It may be due to tenderness or anxiety.
Localized guarding - Suggest localized peritonitis.
Generalized guarding may be due to anxiety.
Rigidity is the  constant contraction of the abdominal wall muscles, always associated it is associted with tenderness, indicative of peritonitis.