Answer
Initially, gentle palpation should determine the context for further examination by determining if peritoneal signs and exquisite tenderness exist and whether the pertinent findings are general or localized. The examiner should focus on the child’s face to detect nonverbal indicators of tenderness. [8] Palpation should always begin with light, soft, circular movements and should start in the area away from the suspected pathology. In this manner, the examiner can establish that portions of the abdomen are free from tenderness and apparent pathology.
As each region is examined, the contents and their potential for pathology should be sequentially palpated. For the solid organs of the abdomen, the liver, the spleen, and any masses, the perimeters of the structure should be defined and a quantitative estimate of the dimensions should be determined and recorded. Hepatomegaly without jaundice should prompt the consideration of storage rather than inflammatory liver disease. The surface should be repeatedly felt to establish whether the structure is homogenous and whether the surface is smooth, irregular, or nodular in addition to defining if it is tender. The qualitative and quantitative findings should be put into a well-defined, reproducible, anatomic context.
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Abdominal palpation of a boy.
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Abdominal auscultation.
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Abdominal auscultation.
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Percussion over the liver.
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Abdominal wall findings from a handlebar injury.
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Abdominal wall findings in a passenger who was restrained with only a lap belt during a motor vehicle accident.
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Location of McBurney point illustrated on the abdomen of a male subject.
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Abdominal quadrants.
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Grey Turner sign. This 40-year-old woman complained of worsening epigastric pain of five days' duration. On examination, she had hypotension, a board-like abdomen, and extensive ecchymoses over her right loin.
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Acute pancreatitis with Cullen sign.
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A person with jaundice due to hepatic failure.
