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The major components of the abdominal exam include observation, percussion, and palpation. Pelvic, genital, and rectal exams, each of which can provide important insights about abdominal symptoms, are discussed in chapters dedicated to those areas.
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When to Perform the Abdominal Exam
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The abdominal exam can be part of a screening exam, although it will have the greatest likelihood of identifying significant findings when patients have risk factors for disease; for example, assessing for signs of liver disease in patients with alcohol use disorder.
The exam should be performed when a patient has symptoms suggestive of abdominal pathology (eg, pain, bloating).
Sometimes, nonspecific symptoms (eg, weight loss, fevers without focal complaints) as well those in a seemingly distant part of the body might also have their root cause in the abdomen. A complete exam covering all organ systems is necessary in these settings.
Early learners should perform as many exams as possible, with the goal of developing skills to become comfortable recognizing the range of normal.
Correlating history and exam findings with definitive diagnoses (eg, made via imaging, endoscopy, labs, or laparoscopy/laparotomy) is a very helpful way of learning.
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When looking, feeling, and percussing, imagine what organs live in the area that you are examining.
The abdomen can be divided into 4 quadrants: right upper, right lower, left upper, and left lower (Figure 8-1). By thinking in anatomic terms, you can remind yourself of what resides in a particular quadrant and therefore what might be identifiable during both normal and pathologic states (Figure 8-2).
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As with all aspects of the exam, it is useful to develop a systematic approach, such that you perform it the same way each time. This develops patterns and muscle memory, helping you to avoid inadvertently skipping any key elements.
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Important information can be gathered from watching the patient and looking at the abdomen. This requires complete exposure of the region.
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