Abdominal Examination Palpation, Percussion

Part II & Auscultation

LIU YANFANG, M.D., Ph.D

Palpate mass
1st Teaching Hospital
Percussion
Henan Medical University
Auscultation
血液科 刘延方 博士后
Signs of common diseases.
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Masses Masses: Physical

„ Characteristics:
„ Location, size, contour,texture, tenderness,
pulsation, movability
„ Physical:
„ Abdominal wall: venter musculi or tendinous
intersections of musculus rectus abdominis
„ Abdominal cavity: lumbar centrum, sacral
promontory骶骨岬, abdominal aorta, inferior pole
of right kidney, transverse colon, sigmoid colon,
cecum盲肠

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Fluidthrill液波震颤
Pathological
„ Shifting or swelling of parenchymatous实质的organ
volume of ascites
„ Distension of hollow viscus
>3000ml
„ Inflammatory masses (abscess or adhesion)

„ Tumor or cyst

„ Lymphadenectasis 淋巴结肿大

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1
 Succussion Splash
„ Caused by increased air and fluid in the
stomach, as seen with pyloric obstruction,
gastric dilatation or large hiatus hernia
Percussion
„ Technique: indirect percussion
„ Normal percussion notes:
„ Tympany: hollow viscus
„ Dullness or flatness: liver, spleen, lumber
muscle, enlarged bladder or uterus

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Abnormal Percussion Notes Dullness Area of Liver

„ Superior border: 1-2
„ Enlarged tympany area：intestinal obstruction, intercostal spaces higher
than inferior lung border
perforation of gastrointerstinal tract
„ Inferior border: 1-2 cm
higher than detected by
„ Enlarged dull area: swelling of parenchymatous
palpation
organ, tumor, ascites „ Liver span:9-11cm (right
midclavicular line)

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Abnormal Percussion Findings Spleen Percussion

„ Enlarged: hepatic congestion, hepatitis, liver „ Location:
abscess, liver carcinoma „ 9th ~11th ICS alongside left midaxillary line
„ Diminished: liver cirrhosis or necrosis „ Diameter:
„ Disappeared: perforation of gastrointestinal „ superio-inferior长度 : 4-7 cm
tract, abdominal surgery „ The anterior border should not exceed anterior
„ Upward shifting : fibrosis or atelectasis of axillary line
right lung, large volume of air or gas in the
„ Abnormal findings:
gastrointestinal tract
„ Enlarged: splenomegaly
„ downward shifting: emphysema, right side
Diminished: too much gas in surrounding organs
pleural effusion, hepatoptosia肝下垂 „

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2
 Traube’s Area胃泡鼓音区 Ascites
„ Shifting dullness:
Free fluid causes air-containing gut to float up to
„ Borders „

the most superior position

„ Upper: left lung, „ The volume of ascites usually exceeds 1000ml if
diaphragm detectable.
„ Lower: Rib
„ Right: liver
„ Left: spleen

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Ascites Ascites and Ovarian Cyst

„ dullness sites

„ Shifting dullness tympany

tympany

„ Ruler pressing test dullness

dullness

Difference of dullness sites

„ Umbilicus between ascites and ovarian cyst
„ Puddle sign: a way to detect small amounts of fluid
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Protruded
umbilicus

ascites Ovarian cyst

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3
 Percussion pain Costovertebral Angle Tenderness
„ Liver area
„ Hepatitis
„ Liver abscess
„ Kidney area
„ Nephritis
„ Pyelonephritis肾盂肾炎
„ Renal tuberculosis
„ Calculus
„ perinephritis

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Percussion of Bladder Auscultation

„ Bowel sounds
„ Principle:peristaltic activity emits various
gurgling and bubbling sounds as air and
fluid interfaces change with contraction
waves.
„ Normal: 4~5/min

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Vascular Sounds
Abnormal:
„ Increased: >10/min: hypermotile states such „ Principle
as acute gastroenteritis, blood in the small „ Turbulent flow in a dilated, constricted, or tortuous
bowel vessel
„ High-pitched tinkling:intestinal fluid and air under „ Bruits
pressure, as in early obstruction „ Epigastrium ; aorta
„ Decreased:postlaparotomy, eletrolyte „ Umbilical or in the flanks ; renal artery
imbalance, senile constipation „ Right hypochondrium ; hepatic artery
„ Absence: acute peritonitis, paralytic ileus „ Venous hum静脉哼鸣
one must listen for at least a full 3 minutes „ Recannulized umbilical vein from portal hypertension
before pronouncing that peristalsis蠕动has „ Large intra-abdominal hemangiomas血管瘤
ceased „ Vena cava and its branches
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4
 Friction Rub Hepatic Cirrhosis
„ Principle:
„ Irritated fibrin-laden
peritoneal surfaces grate
with motion, seen in
localized peritonitis.
„ Scratch sound:
„ Aids in static border definition
„ Inferior border of the liver

„ Ascites (<120ml)

Ｓｃｒａｔｃｈ　ｔｅｓｔ

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Acute Perforated Gastric or

Duodenal Ulcer
„ Inspection:forced supine position, decreased
or disappeared abdominal respiration
„ Palpation: tenderness in epigatrium or RUQ,
rebound tenderness, rigid abdominal wall
„ Percussion: increased resonance over liver,
shifting dullness
„ Auscultation: decreased or absence of bowel
sounds
Writing up the physical examination
The abdomen is obese. Bowel sounds are
present. Percussion notes are normal. There is
a area of significant pain in the right lower
quadrant, immediately above the right
midposition of the inguinal ligament. Rectal
examination discloses severe pain in the same
area. No organomegaly is felt.

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QUESTIONS

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