Clinical Examination of the Abdomen

Patient Positioning

Supine Positioning: The patient must lie flat, flex knees, and arms at the side.
Draping: Expose from xiphoid process to the suprapubic region.

Observation: Check for contour, symmetry, skin lesions, scars, striae, rashes, and pulsations.
Abdomen Shape: Determine if the abdomen is protuberant, rounded, flat, or concave.

Order of Auscultation: Start in the right upper quadrant, move to left upper, left lower, and right lower quadrants.
Bowel Sounds: Listen for normal bowel sounds as indicators of performance.
Abdominal Vessels: Use the bell of the stethoscope for the aorta, renal arteries, iliac arteries, and femoral pulses.

General Percussion: Assess for tympany and dullness in all four quadrants.
Liver Percussion: Start at the umbilical region and move up to find the liver edge.
Spleen Percussion: Use the sixth intercostal space; check for changes on deep inspiration.

Light Palpation: Use pads of fingers in the same order as auscultation, noting any tenderness or facial expressions of discomfort.
Deep Palpation: Assess for deeper tenderness or masses, using rebound tenderness checks.

Murphy's Sign: Check for pain on inspiration in the right upper quadrant as an indicator of cholecystitis.
Psoas Sign: Test for appendicitis using leg lift resistance.
Obturator Sign: Internally rotate the right leg to check for appendicitis.
Heel Tap Test: Check for peritoneal irritation.
Shifting Dullness: Test for ascites by noting changes in percussion notes when patient changes position.
Rovsing's Sign: Deep palpation in one quadrant causing pain in the right lower quadrant suggests appendicitis.

Abdominal Reflexes: Absence of abdominal reflexes can indicate pathology but isn't definitive.
Genitourinary Exam: Required if pain is in or below the umbilicus.
Liver and Spleen Assessment: Liver edge not palpable or tender; spleen is non-palpable.
Abdominal Aorta: Measure for lateral expansion to detect aneurysm; should be less than three centimeters.

This structured approach ensures a thorough evaluation of the abdomen to aid in diagnosis and management of abdominal complaints.