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

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

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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