Abdominal Palpation
October 29th, 2020
On this page:Segments of the AbdomenFocal Abdominal TendernessGeneralised Abdominal TendernessAbdominal Masses
Overview
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.
Abdominal Segments
- ARight hypochondrium - liver, gallbladder, stomach, hepatic flexure of colon, lung
- BEpigastrium - liver, gallbladder, stomach, transverse colon, pancreas, heart
- CLeft hypochondrium - spleen, pancreas, stomach, splenic flexure of colon, lung
- DRight lumbar - ascending colon, kidney
- EUmbilicus - small bowel, aorta
- FLeft lumbar - descending colon, kidney
- GRight iliac fossa- appendix, terminal ileum, caecum, ovary, fallopian tube, ureter
- HHypogastrium - uterus, bladder, sigmoid colon
- ILeft 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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