What preparation is needed before an abdominal exam is performed?

Updated: Dec 02, 2020
  • Author: Simon S Rabinowitz, MD, PhD, FAAP; Chief Editor: Kurt E Roberts, MD  more...
  • Print
Answer

Answer

The key to a successful outcome for an abdominal examination is the thought process of the examiner prior to starting the procedure. The abdominal examination is always a step-wise procedure, and the experienced practitioner should follow the same sequence for all patients, using age-specific modifications to achieve the desired goals. A long list of differential entities can be the cause of abdominal pain; these are well described in standard text books and recent reviews. [9, 10, 11]

Consequently, a complete history should be obtained, and a set of probable diagnostic possibilities should be entertained prior to starting the examination. One useful categorization is described in Table 1 that has been adapted by the authors from several sources. [9, 10, 11] The history should include characterization of the time frame, subjective description, severity, pattern, and location of the pain and other complaints.

Additional essential history would include presence of weight gain or loss, nausea and/or vomiting, change in bowel movements, rectal bleeding, jaundice, abdominal distension, and pruritus. Symptoms suggestive of an urgent, surgical, problem represent a different set of possibilities than those that are consistent with a chronic condition. Similarly, the patient who presents with marked morbidity should suggest different conditions from the one with subjective rather than objective complaints.

Table 1. Commonly Encountered Etiologies of Abdominal Pain in Children Arranged by Age and Characteristics (Open Table in a new window)

 

Infancy (< 2 y)

Preschool Age (2-5 y)

School Age (>5 y)

Adolescent

Gastrointestinal

  • Colic (D)*

  • GER (S)

  • AGE

  • Trauma (possible child abuse)

  • Constipation (P, LLQ)*

  • Milk protein allergy*

  • Hernia (RLLQ)

  • Choledochal cysts (RUQ)

  • AGE (D)*

  • Acid peptic disease (E)*

  • UTI (RLQ, LLQ)

  • Trauma

  • Constipation (P, LLQ)*

  • Colonic distension*

  • Henoch-Schonlein purpura

  • IBD

  • Choledochal cysts (RUQ)

  • Sickle cell crisis

  • Lead poisoning

  • Abdominal trauma

  • Acid peptic disease (E)*

  • UTI (RLLQ)

  • Functional abdominal pain*

  • IBS*

  • Constipation (P, LLQ)*

  • IBD

  • Colonic distension*

  • Parasitic infection

  • Hepatitis (RUQ)

  • Cholelithiasis (RUQ)

  • Diabetes mellitus (DKA)

  • Gastritis (E)*

  • GER (S)*

  • Peptic ulcer (E)

  • IBS*

  • Dyspepsia*

  • IBD

  • Trauma

  • Constipation (P, LLQ)*

  • Colonic distension*

  • Food poisoning

  • UTI (RLLQ)

  • Hepatitis (RUQ)

  • Cholelithiasis (RUQ)Choledochal cyst (RUQ)Pancreatitis (E)

  • Pancreatic pseudocyst

  • Collagen-vascular disease

Surgical abdominopelvic emergencies

  • Intussusception (RLQ)

  • Incarcerated hernia (RLLQ)

  • Volvulus

  • Malrotation

  • Atresias

  • Tumor

  • Appendicitis (RLQ)

  • Meckel diverticulum

  • Malrotation

  • Tumor

  • SBO-related to trauma, IBD, others

  • Appendicitis (RLQ)

  • Testicular torsion (RLLQ)

  • Malrotation

  • Tumor

  • Appendicitis (RLQ)

  • Testicular torsion (RLLQ)

  • Ovarian torsion (RLLQ)

  • Ectopic pregnancy (RLLQ)

  • Cholecystitis (RUQ)

Extra-abdominal

  • Renal enlargement-infection, tumor, anomaly, obstruction (RLLQ)

  • Pneumonia (RLUQ)

  • Asthma (RLUQ)

  • Pyelonephritis (RLLQ)

  • Pneumonia (RLUQ)

  • Asthma (RLUQ)

  • Diabetes mellitus

  • Group A streptococcal pharyngitis

  • Pyelonephritis (RLLQ)

  • Pneumonia (RLUQ)

  • Group A streptococcal pharyngitis

  • Asthma (RLUQ)

  • Nephrolithiasis (RLLQ)

  • Pregnancy (RLLQ)

  • Pelvic inflammatory disease (RLLQ)

  • Dysmenorrhea (RLLQ)

  • Epididymitis (RLLQ)

  • Mittelschmerz (RLLQ)

  • Ovarian cyst (RLLQ)

  • Porphyria

In each box the most commonly encountered etiologies are marked with an asterisk (*). All entities that have a characteristic location have these identified: E= epigastric; RU = right upper quadrant; RL = right lower quadrant; RL = right lower quadrant; LL = left lower quadrant; P = periumbilical; D = diffuse; S = subxiphoid; RLLQ = either right or left lower quadrant; RLUQ = either right or left upper quadrant; IBD = inflammatory bowel disease; IBS = Irritable bowel syndrome; UTI = urinary tract infection; AGE = acute gastroenteritis; acid peptic disease = (reflux esophagitis, gastritis, duodenitis, peptic ulcer); colonic distension (secondary to carbohydrate ie lactose, sucrose, sorbitol malabsorption)


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!