What is the correlation between the physical findings and diagnosis following an abdominal exam?

Answer

Based on the assessment, the examiner should begin with diagnostic possibilities that can be supported or decreased in likelihood by the examination (see Table 2). In all cases, and especially if the history fails to provide specific clues, the examiner should be aware of the common diseases that manifest with abdominal symptoms and should then try to determine if any physical findings consistent with these entities are present. A child with chronic constipation should not be subjected to appendectomy because of severe pain related to colonic distension when they arrive in the emergency room.

Table 2. Correlation of Physical Findings With Diagnostic Possibilities (Open Table in a new window)

Physical Finding	Disease Process to Consider
Epigastric tenderness	Acid peptic disease (GER, gastritis, PUD)
Discomfort with minimal movement	Peritonitis
Distension with fullness left lower quadrant	constipation
Diffuse tenderness with increased tympany	IBS vs small bowel obstruction
Tenderness at McBurney's point	Appendicitis
Tenderness medial to McBurney's point	Meckels diverticulum
Increased tenderness with inspiration in RUQ (Murphy sign)	Gallbladder pathology
Pain with lifting extended right leg against resistance (Psoas sign)	Retrocecal appendicitis or other retroperitoneal irritation (abscess of Crohn disease, pancreatitis, pyelonephritis)
Bulging flanks	Ascites or obesity
Shifting dullness	Ascites
Pain with deep knee squats	Retrocecal appendicitis
"Hepatosplenomegaly" with cephalad borders at lower ribs	Hyperinflation as seen in obstructive pulmonary disease
Hepatomegaly or hepatosplenomegaly with jaundice and/or caput medusae	Cirrhosis with portal hypertension
Hepatomegaly or hepatosplenomegaly without jaundice and normal consistency of enlarged organs	Congestion secondary to heart failure
Hepatomegaly or hepatosplenomegaly without jaundice and firm consistency of enlarged organs	Storage or Infiltrative disease process including leukemia and other neoplasia
Firm hepatomegaly without splenomegaly or jaundice, especially with increased blood pressure	Congenital hepatic fibrosis
Jaundice with liver tenderness, and/or enlargement	Hepatitis
Jaundice with normal liver findings	Gilbert syndrome, hemolytic process, metabolic disease, early hepatitis
Pain relieved by sitting up	Pancreatitis, retroperitoneal pathology
Periumbilical bruising and edema (Cullen's sign)	Hemorrhagic pancreatitis
Bruising of flanks (Grey Turner sign)	Hemorrhagic pancreatic, renal hemorrhage
Isolated splenomegaly	Splenic trauma, extra-hepatic portal hypertension, splenic sequestration, hemolytic diseases, certain storage diseases

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Table 2. Correlation of Physical Findings With Diagnostic Possibilities

Table 2. Correlation of Physical Findings With Diagnostic Possibilities

Physical Finding	Disease Process to Consider
Epigastric tenderness	Acid peptic disease (GER, gastritis, PUD)
Discomfort with minimal movement	Peritonitis
Distension with fullness left lower quadrant	constipation
Diffuse tenderness with increased tympany	IBS vs small bowel obstruction
Tenderness at McBurney's point	Appendicitis
Tenderness medial to McBurney's point	Meckels diverticulum
Increased tenderness with inspiration in RUQ (Murphy sign)	Gallbladder pathology
Pain with lifting extended right leg against resistance (Psoas sign)	Retrocecal appendicitis or other retroperitoneal irritation (abscess of Crohn disease, pancreatitis, pyelonephritis)
Bulging flanks	Ascites or obesity
Shifting dullness	Ascites
Pain with deep knee squats	Retrocecal appendicitis
"Hepatosplenomegaly" with cephalad borders at lower ribs	Hyperinflation as seen in obstructive pulmonary disease
Hepatomegaly or hepatosplenomegaly with jaundice and/or caput medusae	Cirrhosis with portal hypertension
Hepatomegaly or hepatosplenomegaly without jaundice and normal consistency of enlarged organs	Congestion secondary to heart failure
Hepatomegaly or hepatosplenomegaly without jaundice and firm consistency of enlarged organs	Storage or Infiltrative disease process including leukemia and other neoplasia
Firm hepatomegaly without splenomegaly or jaundice, especially with increased blood pressure	Congenital hepatic fibrosis
Jaundice with liver tenderness, and/or enlargement	Hepatitis
Jaundice with normal liver findings	Gilbert syndrome, hemolytic process, metabolic disease, early hepatitis
Pain relieved by sitting up	Pancreatitis, retroperitoneal pathology
Periumbilical bruising and edema (Cullen's sign)	Hemorrhagic pancreatitis
Bruising of flanks (Grey Turner sign)	Hemorrhagic pancreatic, renal hemorrhage
Isolated splenomegaly	Splenic trauma, extra-hepatic portal hypertension, splenic sequestration, hemolytic diseases, certain storage diseases

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