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Gastro Exam

Abdominal Palpation

October 29th, 2020


Ask the patient to indicate where on the abdomen is painful. Superficially palpate the nine segments of the abdomen to elicit tenderness and assess for masses. If no tenderness is present, palpate more deeply.

Segments of the Abdomen

For the purposes of clinical examination, the abdomen is broken into nine segments, each of which contain important organs to assess.
  • Segments of the Abdomen
  • Abdominal Segments

  • A
    Right hypochondrium - liver, gallbladder, stomach, hepatic flexure of colon, lung
  • B
    Epigastrium - liver, gallbladder, stomach, transverse colon, pancreas, heart
  • C
    Left hypochondrium - spleen, pancreas, stomach, splenic flexure of colon, lung
  • D
    Right lumbar - ascending colon, kidney
  • E
    Umbilicus - small bowel, aorta
  • F
    Left lumbar - descending colon, kidney
  • G
    Right iliac fossa- appendix, terminal ileum, caecum, ovary, fallopian tube, ureter
  • H
    Hypogastrium - uterus, bladder, sigmoid colon
  • I
    Left Iliac Fossa - sigmoid colon, ovary, fallopian tube, ureter

Focal Abdominal Tenderness

  • Feel For

  • Tenderness within a single region of the abdomen.
  • Interpretation

  • Right hypochondriumGallstones, peptic ulcer
  • EpigastriumPancreatitis, peptic ulcer, reflux
  • Left hypochondrium Peptic ulcer, pancreatitis
  • Right lumbarKidney stone, pyelonephritis
  • UmbilicusPancreatitis, early appendicitis, peptic ulcer, IBD
  • Left lumbarKidney stone, diverticulitis, IBD
  • Right iliac fossaAppendicitis, caecal diverticulitis, ovarian pathology, ectopic pregnancy, PID, inguinal hernia
  • HypogastriumCystitis, appendicitis, diverticulitis, IBD, uterine pathology
  • Left Iliac FossaSigmoid diverticulitis, ovarian pathology, ectopic pregnancy, PID, inguinal hernia

Generalised Abdominal Tenderness

  • Feel For

  • Generalised tenderness over more than one abdominal segment.
  • Significance

  • A feature of peritonism, suggestive of peritonitis.
  • Causes of Peritonitis

  • 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

Abdominal Masses

  • Feel For

    A palpable mass within the abdomen, noting its:
  • Location
  • Size
  • Shape
  • Consistency
  • Mobility
  • Causes of Abdominal Mass

  • Gastrointestinal - faecal loading, tumour, bezoar, appendiceal abscess, diverticular abscess
  • Hepatobiliary - hepatomegaly, gallbladder enlargment
  • Pancreatic - pancreatic cancer
  • Renal - polycystic kidney disease, transplanted kidney, renal cell carcinoma
  • Vascular - abdominal aortic aneurysm
  • Hernia
  • Lymphoma
  • Interpretation

  • Right hypochondriumHepatomegaly, gallbladder enlargement, pancreatic head carcinoma
  • Left hypochondriumPancreatic tumour, gastric tumour
  • Right lumbarRenal tumour, polycystic kidney
  • UmbilicusAbdominal aortic aneurysm, umbilical hernia
  • Left lumbarRenal tumour
  • Right iliac fossaTransplanted kidney, appendiceal abscess, caecal tumour, hernia, faecal loading
  • HypogastriumUrinary retention, faecal loading, sigmoid tumour
  • Left iliac fossaDiverticular abscess, sigmoid tumour, hernia, faecal loading
  • FlankRenal cyst / tumour, retroperitoneal lymphoma
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