Test: Abdominal Palpation

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Background/Purpose

Palpation is the examination of the abdomen for crepitus of the abdominal wall, for any abdominal tenderness, or for abdominal masses. The liver and kidneys may be palpable in normal individuals, but any other masses are abnormal.

Procedure

The abdominal wall skin should be inspected carefully for abnormalities. Any areas of discoloration should be noted, such as the bluish discoloration of the umbilicus (Cullen's sign) or flanks (Grey Turner's sign). The skin should be inspected for striae, or "stretch marks," and surgical scars. Careful note of surgical scars should be made and correlated with the patient's recollection of previous operations. The skin of the abdomen should also be checked carefully for engorged veins in the abdominal wall and the direction of blood flow in these veins. This is performed by placing the tips of the index fingers together, compressing a visible vein. The fingertips are then slid apart, maintaining compression, producing an empty venous segment between the fingers. A finger is removed from one end and the vein is watched for filling. The procedure is then repeated, but the opposite finger is removed and the vein again checked for filling. Above the umbilicus, blood flow is normally upward; below the umbilicus, it is normally downward. Obstruction of the inferior vena cava will cause reversal of flow in the lower abdomen. In addition to these large dilated veins, note should be made of any spider angiomas of the abdominal wall skin.

Next, the abdomen should be inspected for masses. This should be performed from several angles. It is important to differentiate abdominal wall from intra-abdominal masses. A mass of the abdominal wall will become more prominent with tensing of the abdominal wall musculature, whereas an intra-abdominal mass will become less prominent or disappear. Useful maneuvers are to have the patient hold his head unsupported off the examining table, to hold his nose and blow, or to raise his feet off the table. Abdominal wall masses are most commonly hernias (either umbilical, epigastric, incisional, or spigelian), neoplasms (benign and malignant), infections, and hematomas.
Performed: Bilaterally

Dialog

Superficial and deep palpation of the abdomen.

Criteria

• No masses
• No tenderness
• No rigidity

Measurement

LOINC Code

Scale/Grading

selection range; grade - LOINC ID
Option - Value option selection range; grade - LOINC IDPass ; Pass - Fail ; Fail -