Abdominal Exam III: Palpation
Source: Alexander Goldfarb, MD, Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, MA
Abdominal palpation, if performed correctly, allows for examination of the large and relatively superficial organs; for a skilled examiner, it allows for assessment of the smaller and deeper structures as well. The amount of information that can be obtained by palpation of the abdominal area also depends on the anatomical characteristics of the patient. For example, obesity might make palpation of internal organs difficult and require that additional maneuvers be performed. Abdominal palpation provides valuable information regarding localization of the problem and its severity, as abdominal palpation identifies the areas of tenderness as well as presence of organomegaly and tumors. The specific focus of palpation is driven by the information collected during history taking and other elements of the abdominal exam. Palpation helps to integrate this information and develop the strategy for subsequent diagnostic steps.
1. Light palpation
Light palpation allows for determination of the areas of tenderness and abdominal wall resistance due to rigidity (involuntary muscle spasm) or guarding (voluntary contraction of the abdominal wall musculature). It also permits identification of the superficial organs or masses, or, much less frequently, crepitus of the abdominal wall (caused by gas or fluid within the subcutaneous tissues).
- Make sure that the patient is positioned correctly, and explain the proc
Abdominal palpation is the final and an important part of the abdominal exam. This part of physical diagnosis is especially informative when evaluating a patient presenting abdominal pain, as it provides insight into localization, cause, and severity of the problem. One must remember to start with the superficial palpation and follow with the deep palpation, systematically going through all the abdominal regions. As in the other sections of the abdominal examination, the patient should be comfortably positioned and relax
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