Abdomen

Abdominal auscultation should be performed prior to palpation and percussion, as these actions may disrupt normal bowel sounds.

Findings on Abdominal and Pelvic Examination

Component	Inspection	Auscultation	Palpation	Percussion
General
Respiratory
Cardiovascular	Femoral access sites		Liver Size Pulsatility
Neurological
Endocrine and Metabolic
Renal
Gastrointestinal	Jaundice Caput medusae Distension Cullen’s sign Grey-Turner’s sign Tubes PTC PEG PEJ	Bowel sounds Hepatic arterial bruit Hepatic venous hum Hepatic friction rub	Tenderness Guarding Liver Size Pulsatility Liver Texture Pulsatility Splenomegaly	Air Intestinal Extra-intestinal Fluid
Haematological			Hepatomegaly Splenomegaly
Integumentary
Trauma	Seatbelt sign
Infective
Malignant
Toxic
Immune			Lymphadenopathy
Congenital
Obstetric	Fundal examination Height Presenting part Lie Liquor volume

Findings

Gastrointestinal

• Caput medusae
  Prominent periumbilical veins indicate portosystemic collateral formation secondary to portal hypertension or IVC syndrome.

Caput medusae

• Bowel sounds
  Presence of normal bowel sounds is a strong predictor of normal bowel perfusion in the critically ill. Absence is generally non-specific, although no sounds for >60s may indicate paralytic ileus.
  
  
• Hepatic venous hum
  Continuous roaring noise suggestive of portal hypertension.
  
  
• Hepatic friction rub
  Suggestive of hepatic capsular inflammation and malignancy.
  
  
• Percussion for ascites
  • Dependent ascites produces a dull sound
    Absence of flank dullness suggests no ascites is present.
    
    
• Percussion for liver size
  Note the change from resonance to dullness, percussing caudally from the right hemithorax to the abdomen.
  
  
• Liver palpation
  Advance the hand from the right iliac fossa towards the right costal margin. Ascertain:
  • Texture
    Hard or soft.
  • Surface
    Regular or irregular.
  • Tenderness
    Indicates capsular tension.
  • Pulsatility

Trauma

• Seatbelt sign
  Abdominal (and/or chest) wall bruising associated with a 3-point restraint. Indicates a high-energy mechanism and a high risk of internal injury.

Seatbelt sign

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References

1. Foot C, Steel L, Vidhani K, Lister B, MacPartlin M, Blackwell N. Examination Intensive Care Medicine. Elsevier Australia; 2011. (Examination series).