(Before starting the examination, ensure a thorough GIT history has been taken)
• In the presence of a female attendant (if female patient).
Inspection
• Shape of abdomen: Flat / Scaphoid / Rounded / Distended (Generalized / Localized)
• Symmetry: Symmetrical / Asymmetrical
• Movement with respiration: Present / Reduced / Absent
• Umbilicus:
- Position: Central / Deviated
- Nature: Inverted / Everted
• Flanks: Normal and symmetrical / Fullness present
• Skin over abdomen:
- Colour and texture: Normal / Abnormal
- Scars: Present / Absent
- Sinuses/Fistulae: Present / Absent
- Striae: Present / Absent
- Dilated veins: Present / Absent
(Caput medusae / Inferior vena caval obstruction)
• Visible pulsations: Present / Absent
• Visible peristalsis: Present / Absent
• Localized swelling/fullness:
- Site (Quadrant/Region): ______________
- Size:___×___cm
- Relation to landmarks (costal margin/midline/umbilicus): ______________
- Skin over swelling: Normal / Erythematous
• Hernial swellings:
- Inguinal: Present / Absent
- Femoral: Present / Absent
- Umbilical: Present / Absent
⸻
Palpation
(Patient examined with hips and knees slightly flexed.)
Superficial Palpation
• Local rise of temperature: Present / Absent
• Tenderness: Present / Absent
• Guarding: Present / Absent
• Rigidity: Present / Absent
• Rebound tenderness: Present / Absent
Deep Palpation
• Abdomen: Soft / Firm / Rigid
• Palpable mass: Present / Absent
If present:
- Site: ______________
- Size:___×___cm
- Shape:_______________
- Margins: Well-defined / Ill-defined
- Consistency: Soft / Firm / Hard / Cystic
- Tenderness: Present / Absent
- Mobility: Mobile / Fixed
- Relation to overlying skin: Attached / Not attached
- Relation to underlying structures: Fixed / Mobile
- Movement with respiration: Present / Absent
- Pulsatility: Present / Absent
- Fluctuation: Present / Absent
- Skin over swelling: Normal / Erythematous
• Liver
- Not palpable / Palpable __ cm below right costal margin in right mid-clavicular line.
- Surface: Smooth / Nodular
- Margin: Sharp / Rounded
- Consistency: Soft / Firm / Hard
- Movement with respiration: Present / Absent
• Spleen
- Not palpable / Palpable __ cm below left costal margin.
- Extends towards: Midline / Right iliac fossa
- Surface: Smooth / Nodular
- Margin: Sharp/smooth
- Notches: palpable / not Palpable
- Consistency: Soft / Firm / Hard
- Tenderness: Present / Absent
- Movement with respiration: Present / Absent
• Kidneys
- Right kidney ballotable: Yes / No
- Left kidney ballotable: Yes / No
• Gall Bladder
- Palpable / Not palpable
• Urinary Bladder
- Palpable / Not palpable
• Abdominal Aorta
- Normally pulsatile and non-expansile / Expansile pulsation present
• Ascites
- Fluid thrill: Present / Absent
- Shifting dullness: Present / Absent
• Hernial Orifices
- Normal / Abnormal
- Inguinal hernia: Present / Absent
- Femoral hernia: Present / Absent
- Umbilical hernia: Present / Absent
⸻
Percussion
• Predominant note over abdomen: Tympanitic / Dull
• Liver dullness: Present in right hypochondrium
• Traube’s space: Resonant / Dull
• Localized areas of dullness:
- Present / Absent
- Site: ______________
• Shifting dullness: Present / Absent
• Fluid thrill: Present / Absent
• Evidence of free fluid in peritoneal cavity: Present / Absent
⸻
Auscultation
• Bowel sounds:
- Normal (5–30/min)
- Hyperactive
- Hypoactive
- Absent
• Bruits over:
- Abdominal aorta: Present / Absent
- Renal arteries: Present / Absent
- Iliac arteries: Present / Absent
- Femoral arteries: Present / Absent
• Friction rub: Present / Absent
⸻
The patient is conscious and oriented to time, place and person. He/She is examined in a well-lit room, adequately exposed, in sitting position, after taking verbal consent, in presence of female attendant.
On General physical examination, His/her pulse rate is 68 beats/min, regularly regular, normal volume and character, all peripheral pulses are palpable, no radio-radial or radio-femoral delay, no vessel wall thickening. His/her Blood pressure is 128/76 mm of Hg, from right arm in sitting position, by Auscultatory method. His/Her Respiratory rate is 18 times/ min, Thoraco-abdominal/ abdomino-thoracic, without use of any accessory muscles. His/her axillary temperature is 98.6 degree F.
No Pallor, Icterus, Cyanosis, Clubbing, Edema or Lymphadenopathy.
On Inspection, the abdomen appears symmetrical and moves normally with respiration. The shape of the abdomen is normal and may be described as flat/scaphoid/rounded according to findings. The umbilicus is centrally placed and inverted/everted. The flanks appear normal and symmetrical / flank fullness is present. The skin over the abdomen appears normal in colour and texture.
There are no scars, sinuses, dilated veins (caput medusae or IVC obstruction), striae, sinuses, fistulae, visible pulsations, or visible peristalsis. No fullness or bulge is noted in any region of the abdomen. No localized swelling is seen in the epigastric, umbilical, hypochondrial, lumbar, iliac, suprapubic, or inguinal regions [if present, explain: A solitary globular swelling of size approximately __×__ cm is present over _____ quadrant, approximately _____________ (relation with any bony prominence / costal margin / midline). The skin above the swelling appears smooth, with no erythema, sinus, or pulsation.] The groins appear normal with no visible hernia.
- Distension of the abdomen – generalized or localized
- Fullness of flanks suggestive of ascites
- Scars of previous surgeries
- Dilated veins (caput medusae or inferior vena caval obstruction)
- Visible peristalsis suggestive of intestinal obstruction
- Visible pulsations suggestive of abdominal aortic aneurysm
- Localized swelling in any abdominal quadrant
- Everted umbilicus due to ascites or large intra-abdominal mass
- Hernial swellings in inguinal, femoral, or umbilical regions
On palpation, the abdomen is examined with the hips and knees slightly flexed.
The abdomen feels soft and non-tender, no guarding or rigidity or local rise in temperature. No rebound tenderness is elicited. No palpable mass is detected in any of the nine regions of the abdomen [if present: A solitary globular lump of size __×__ cm is present over the _____ region of abdomen, _____________ (relation with costal margin / umbilicus / midline). The lump is firm in consistency, has a smooth surface and smooth margins, is non-tender and non-pulsatile, with no erythema or local rise in temperature. It is fixed to the underlying structure, not attached to overlying skin. Fluctuation as well as trans illumination not present. The skin above the swelling is smooth.]
The liver is not palpable below the right costal margin [if palpable: liver extending ____ cm below the right costal margin in the right mid-clavicular line — smooth/nodular surface, sharp/rounded margin, soft/firm/hard consistency, tender/non-tender, moves with respiration].
The spleen is not palpable [if palpable: The spleen is palpable ____ cm below the left costal margin and extends ____ cm towards the midline/right iliac fossa — smooth/nodular surface, sharp margin with palpable notch(es), soft/firm/hard consistency, tender/non-tender, moves with respiration].
Both kidneys are not ballotable. The gall bladder is not palpable. The urinary bladder is not palpable. The abdominal aorta is normally pulsatile and not expansile. There is no fluid thrill or shifting dullness. The hernial orifices are normal.
- Local rise of temperature and tenderness suggestive of inflammation
- Guarding and rigidity suggestive of peritonitis
- Rebound tenderness indicating peritoneal irritation
- Hepatomegaly – enlarged liver palpable below the right costal margin
- Splenomegaly – enlarged spleen palpable below the left costal margin
- Palpable kidneys due to hydronephrosis or enlargement
- Palpable gall bladder (Courvoisier's law)
- Distended urinary bladder
- Intra-abdominal masses characterized by site, size, shape, surface, margins, consistency, tenderness, mobility, and relation to respiration
- Fluid thrill and shifting dullness suggestive of ascites
- Expansile pulsation suggestive of abdominal aortic aneurysm
On percussion, the abdomen is predominantly tympanitic. Liver dullness is present in the right hypochondrium. Traube's space is resonant. No shifting dullness or fluid thrill is demonstrable. There is no evidence of free fluid in the peritoneal cavity.
- Generalized dullness suggestive of ascites
- Dullness over a localized area suggestive of an intra-abdominal mass or enlarged organ
- Obliteration of liver dullness suggestive of pneumoperitoneum
- Dullness in Traube's space suggestive of splenomegaly
- Shifting dullness and fluid thrill indicating ascites
Bowel sounds are heard and are normal in frequency (approximately 5–30 sounds per minute). No bruit is heard over the abdominal aorta, renal arteries, iliac arteries, or femoral arteries. No venous hum or friction rub is present.
- Hyperactive bowel sounds – intestinal obstruction, gastroenteritis
- Absent bowel sounds – paralytic ileus or peritonitis
- High-pitched tinkling bowel sounds – acute intestinal obstruction
- Bruit over the abdominal aorta – abdominal aortic aneurysm
- Renal artery bruit – renal artery stenosis
- Venous hum – portal hypertension
- Friction rub over liver or spleen – inflammatory or neoplastic lesions
