Abdominal Palpation
Abdominal Tenderness
- Ask the patient to indicate where on the abdomen is painful. Superficially palpate the nine segments of the abdomen to elicit tenderness. If none is present, palpate more deeply.
Interpretation
- Right hypochondrium - liver, gallbladder, stomach, hepatic flexure of colon, lungGallstones, peptic ulcer
- Epigastrium - liver, gallbladder, stomach, transverse colon, pancreas, heartPancreatitis, peptic ulcer, reflux
- Left hypochondrium - spleen, pancreas, stomach, splenic flexure of colon, lungPeptic ulcer, pancreatitis
- Right lumbar - ascending colon, kidneyKidney stone, pyelonephritis
- Umbilicus - small bowel, aortaPancreatitis, early appendicitis, peptic ulcer, IBD
- Left lumbar - descending colon, kidneyKidney stone, diverticulitis, IBD
- Right iliac fossa - appendix, terminal ileum, caecum, ovary, fallopian tube, ureterAppendicitis, caecal diverticulitis, ovarian pathology, ectopic pregnancy, PID, inguinal hernia
- Hypogastrium - uterus, bladder, sigmoid colonCystitis, appendicitis, diverticulitis, IBD, uterine pathology
- Left iliac fossa - sigmoid colon, ovary, fallopian tube, ureterSigmoid diverticulitis, ovarian pathology, ectopic pregnancy, PID, inguinal hernia
Signs of Peritonism
- Peritonism refers to inflammation of the peritoneum, which suggests acute abdominal pathology that should be rapidly diagnosed and treated.
Signs of Peritonism
- Generalised abdominal tenderness
- Percussion tenderness - gently percuss the abdominal wall over an area of tenderness. Note whether percussion tenderness is localised or generalised.
- Rebound tenderness - apply pressure to the patient's abdomen over a tender area for 5-10 seconds. Remove the pressure suddenly, and ask the patient if it hurts more when you press or remove your hand.
Causes of Peritonism
- Infection post perforation - appendix, diverticulitis, IBD, perforated ulcer, surgical anastomosis
- Spontaneous bacterial peritonitis (SBP)
- Blood - endometriosis, ruptured ovarian cyst, trauma
- Bile - post-surgical
- Urine - pelvic trauma
- Pancreatic fluid - pancreatitis
Last updated on April 15th, 2020
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