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Abdominal Palpation – Clinical Examination Explained

Abdominal palpation is a clinical examination technique in which a physician uses their hands to feel the abdomen, assessing organs, tenderness, and abnormalities.

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Things worth knowing about "Abdominal Palpation"

Abdominal palpation is a clinical examination technique in which a physician uses their hands to feel the abdomen, assessing organs, tenderness, and abnormalities.

What is Abdominal Palpation?

Abdominal palpation is the systematic manual examination of the abdomen performed by a physician or healthcare professional. It is a fundamental component of the physical examination and provides important diagnostic information about the condition of internal organs and possible abdominal disorders. The technique requires no technical equipment and is performed using both hands.

How the Examination is Performed

Abdominal palpation is typically carried out in two steps:

Superficial palpation: The examiner places their hands flat on the abdomen and applies gentle pressure to detect muscle guarding, tenderness, and surface abnormalities.
Deep palpation: With increased pressure, deeper structures such as the liver, spleen, kidneys, and intestines are assessed for enlargement, masses, or tenderness.

The examination is performed systematically across the abdominal regions, usually beginning in areas away from reported pain before moving toward the affected site. The patient lies relaxed in a supine position with knees slightly bent to relax the abdominal wall.

Clinical Relevance and Applications

Abdominal palpation provides valuable diagnostic clues in a wide range of conditions:

Appendicitis: Tenderness at the McBurney point in the right lower quadrant
Liver disease: Enlarged or hardened liver (hepatomegaly)
Splenomegaly: Palpable spleen, often seen in infectious or hematologic conditions
Cholecystitis: Murphy sign -- pain under the right costal margin during deep inspiration
Bowel disorders: Masses or tenderness in Crohn disease, ulcerative colitis, or colorectal tumors
Ascites: Detection of free fluid in the abdominal cavity
Hernias: Palpable defects or protruding tissue

Findings and Their Interpretation

The following findings may be identified during abdominal palpation:

Muscle guarding (defense musculaire): Involuntary abdominal rigidity, suggesting peritonitis or an acute abdomen
Rebound tenderness (Blumberg sign): Pain upon sudden release of pressure, characteristic of peritoneal irritation
Point tenderness: Localized pain on pressure, indicating an inflammatory process
Masses or induration: Palpable abnormalities that may suggest tumors, cysts, or abscesses

Limitations of the Method

Abdominal palpation is an orientation-level examination with certain limitations. In obese patients, in cases of significant muscle guarding, or with deeply positioned organs, findings may be difficult to assess. Further diagnostic workup often involves imaging techniques such as ultrasound (sonography), CT scan, or MRI to confirm or clarify findings.

References

Bickley, L. S.: Bates' Guide to Physical Examination and History Taking. Wolters Kluwer, current edition.
Swartz, M. H.: Textbook of Physical Diagnosis: History and Examination. Elsevier, current edition.
World Health Organization (WHO): Clinical Examination Guidelines -- available at www.who.int

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