Name: abdominal palpation for organ and pain assessment
Uploaded: 2023-04-30T06:38:08.000Z
Duration: 8 min 25 s
Channel: JoVE

K12 Standards

new-york-state-science-learning-standards

New York State Science Learning Standards

High School

Life Science

Structure and Function

HS-LS1-3.

Abdominal Exam III: Palpation

1. Light palpation
Light palpation allows for determination of the areas of tenderness and abdominal wall resistance due to rigidity (involuntary muscle spasm) or guarding (voluntary contraction of the abdominal wall musculature). It also permits identification of the superficial organs or masses, or, much less frequently, crepitus of the abdominal wall (caused by gas or fluid within the subcutaneous tissues).
<ol>
	<li>Make sure that the patient is positioned correctly, and explain the procedure.</li>
	<li>Ask the patient to indicate the area of pain or tenderness, and examine this area last (to avoid generalized abdominal resistance due to apprehension). Examine the painful areas gently, and don&#39;t try to re-elicit the pain.</li>
	<li>To improve the abdominal relaxation, you might need to have the patient change position or lie with the knees bent. You might also need to ask the patient to breathe abdominally, while you move your hand up and down and trying to palpate as the abdominal wall moves during the inspiration/expiration cycles. These measures usually decrease voluntary guarding.</li>
	<li>Using your dominant hand, keep your fingers together and press to a depth of approximately 1 cm using the pads (flat surfaces) of your fingers with a gentle circular motion.</li>
	<li>Examine all of the abdominal regions, moving in a clockwise direction. Slightly lift your hand as you move to a different spot, and avoid sudden jabs.</li>
	<li>If the patient is ticklish, ask place the patient&#39;s hand under yours, and then slip your hand underneath the patient&#39;s hand after a few moments.</li>
	<li>As you palpate, watch the patient&#39;s face for any signs of discomfort or pain.</li>
	<li>Note the presence of irregularities of the abdominal wall, superficial organs or masses, and crepitus (crunching feeling during palpation produced by gas or fluid within subcutaneous tissues).</li>
</ol>
2. Deep palpation
While the superficial palpation provides information about potential areas of tenderness, superficial structures, and the abdominal wall, deep palpation permits inspection of the internal organs and delineation of the intra-abdominal masses. Additional areas of tenderness could be identified by deep palpation as well.
<ol>
	<li>Start with the quadrant opposite to the one where the pain is located. Continue watching the patient&#39;s face for signs of pain or discomfort as you proceed.</li>
	<li>Place the flat of your hand on the abdominal wall, and apply firm pressure downward and longitudinally. Keep your fingers relatively fixed on the skin, and use a rolling motion.</li>
	<li>Use the two-hand palpation in obese patients or if voluntary muscle resistance is present.
	<ol>
		<li>Place your non-dominant hand on top of your dominant hand.</li>
		<li>Keep the lower hand relaxed, and press with the fingers of the upper hand on the distal phalangeal joints of the lower hand. This way, one hand produces the pressure while the other is used to feel.</li>
	</ol>
	</li>
	<li>Palpate over the all four abdominal quadrants. The palpable abdominal organs include the liver, caecum, sigmoid colon, and, sometimes, the transverse colon and stomach. Enlarged kidneys, gall bladder, spleen, and aortic masses might be palpable as well. (Figure 1)</li>
</ol>
3. Liver palpation
The lower edge of the liver can be palpable on inspiration about 3 cm below the right rib cage. The liver palpation can be performed with one hand or bimanually, and in the case of obese patients, the so-called &#34;hooking&#34; technique might be helpful as well.
<ol>
	<li>One-hand liver palpation
	<ol>
		<li>Place your right hand on patient&#39;s abdomen, lateral to the rectus muscle, well below the level of percussed border of liver dullness.</li>
		<li>Orient your fingers towards the patient&#39;s head or slightly diagonally towards the midline. Press your fingers firmly in and up (towards the patient&#39;s head).</li>
		<li>Ask the patient to take a deep breath. On inspiration, the liver descends, and its edge meets the fingertips of the palpating hand.</li>
		<li>Continue palpating, moving your hand toward the coastal margin until you feel the liver edge (usually a few cm below right costal margin). Note liver edge texture and regularity. Slight tenderness on palpation is normal.</li>
		<li>When your fingers meet the liver edge, slightly reduce the pressure on the abdominal wall while the patient is still taking a deep breath in. This maneuver allows the examiner to feel the anterior liver surface as it slips under the finger pads. Make a note of the consistency of the liver surface-nodes, granularity, etc. (Figure 2)</li>
	</ol>
	</li>
	<li>Bimanual liver palpation
	<ol>
		<li>Place your left hand posteriorly at the level of the patient&#39;s two lower ribs, and gently press upward to elevate the liver into a more accessible position.</li>
		<li>Ask the patient to take a deep breath, and perform palpation with your right hand as described above.</li>
	</ol>
	</li>
	<li>The &#34;hooking&#34; technique 
	This can be helpful when the liver is not palpable by the standard techniques.
	<ol>
		<li>Stand on the right of the patient, facing the patient&#39;s feet.</li>
		<li>Place your flexed fingers over the edge of costal margin.</li>
		<li>Ask the patient to take a deep breath and try to feel the liver edge as you press downward and upward (towards the patient&#39;s head).</li>
	</ol>
	</li>
</ol>
4. Spleen palpation
A normal-sized spleen is rarely palpable. Occasionally, the tip of the spleen can be felt at the left costal margin. When the spleen is significantly enlarged, it displaces the stomach and expands downward below the rib cage and medially across the abdomen, and might be felt as low as at right lower quadrant (Figure 3).
<ol>
	<li>Ask the patient to take a deep breath; then, try to palpate the lower margin of the spleen during expiration.</li>
	<li>Starting in the right lower quadrant, move your fingers slightly up with each inspiration-expiration.</li>
	<li>Palpate pressing down and towards the patient&#39;s head and then releasing, in the same motion as for palpating of the lower edge of the liver.</li>
	<li>If the spleen is not felt, repeat the exam with patient lying on the right side.</li>
	<li>Some examiners use the bimanual palpation technique, during which the palpation is performed with the right hand while the left hand of the examiner is placed behind the left rib cage, and is pressed on the ribs and soft tissues upwards.</li>
</ol>
5. Kidney palpation
Kidneys are retroperitoneal organs and are rarely palpable in a healthy adult. Sometimes enlarged kidneys can be assessed using bimanual &#34;balloting&#34; technique (derived from the French word ballotte, meaning &#34;toss&#34;). The palpating hand is positioned in the upper quadrant lateral to the rectus muscle, while the other hand is placed at the costophrenic angle and is pressing upwards (thus bringing the kidney closer to the anterior abdominal wall) (Figure 4). The maneuver is performed on deep inspiration, when the kidneys descend, and one might feel their lower poles.
<ol>
	<li>To palpate the right kidney, ask the patient to take a deep breath, and palpate with your upper hand while pressing forward with your lower hand position at the right costophrenic angle.</li>
	<li>Attempt to &#34;capture&#34; the kidney between your hands, or feel it with your upper hand.</li>
	<li>If you feel the kidney on inspiration, ask the patient to exhale deeply and hold the breath for a moment. You might feel the kidney moving back to its expiratory position.</li>
	<li>Repeat the maneuver on the left side. Some examiners prefer to stand on the left side of the patient, and palpate with the left hand while balloting the kidney with the right hand; other examiners palpate with the right hand, reaching with the left hand over the patient.</li>
</ol>

Abdominal palpation is the final and an important part of the abdominal exam. This part of physical diagnosis is especially informative when evaluating a patient presenting abdominal pain, as it provides insight into localization, cause, and severity of the problem. One must remember to start with the superficial palpation and follow with the deep palpation, systematically going through all the abdominal regions. As in the other sections of the abdominal examination, the patient should be comfortably positioned and relax...

abdominal exam iii: palpation

Source: Alexander Goldfarb, MD, Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, MA
Abdominal palpation, if performed correctly, allows for examination of the large and relatively superficial organs; for a skilled examiner, it allows for assessment of the smaller and deeper structures as well. The amount of information that can be obtained by palpation of the abdominal area also depends on the anatomical characteristics of the patient. For example, obesity might make palpation of internal organs difficult and require that additional maneuvers be performed. Abdominal palpation provides valuable information regarding localization of the problem and its severity, as abdominal palpation identifies the areas of tenderness as well as presence of organomegaly and tumors. The specific focus of palpation is driven by the information collected during history taking and other elements of the abdominal exam. Palpation helps to integrate this information and develop the strategy for subsequent diagnostic steps.

Source: Alexander Goldfarb, MD, Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, MA
Abdominal palpation, if performed correctly, ...

Skillful abdominal palpation allows for examination of the large and relatively superficial organs, and some of the smaller and deeper structures as well. This technique provides valuable information regarding localization of the problem and its severity as it identifies the areas of tenderness as well as the presence of organomegaly and tumors.In Abdominal Exam Part I, we focused on inspection and auscultation. In Part II, we discussed the essential percussion steps for assessing various abdominal structures. Here, we'll discuss the importance of the different types of abdominal palpation followed by a review of the steps a clinician should perform to evaluate different abdominal structures.Basically, there are two types, light and deep palpation. As the name suggests, light palpation is more superficial and therefore it permits identification of the superficial organs or masses, and sometimes it can detect abdominal wall crepitus.On the other hand, deep palpation allows examination of organs including the liver, caecum. sigmoid colon and, sometimes, transverse colon, and stomach. Deep palpation can also help detect enlarged kidneys, gall bladder and spleen, as, in a healthy state, these organs are rarely palpable. In addition, it can help in diagnosis of aortic aneurysm. With this background information, let's see how to perform a comprehensive abdominal palpation exam.First, we'll go over the light palpation steps. Make sure that the patient is positioned correctly. Explain the procedure and obtain the patient's consent before starting the exam. Drape the patient in a way that maintains their modesty, but doesn't compromise the exam. Ask the patient to indicate the area of pain or tenderness. Make a note of this, and examine this area last, to avoid abdominal resistance due to apprehension. To improve the abdominal relaxation, you can ask the patient to bend their knees. You might also need to ask the patient to breathe with their abdomen, while placing your hand on it and trying to palpate. These measures usually decrease voluntary guarding.For light palpation, use your dominant hand, keep your fingers together and press to a depth of approximately 1 cm using the finger pads with a gentle circular motion. Slightly lift your hand as you move to a different spot and avoid sudden jabs. Examine all of the abdominal regions, moving in a clockwise or anti-clockwise direction. As you palpate, watch the patient's face for any signs of discomfort or pain. Also note irregularities of the abdominal wall, superficial organs or masses, and crepitus if present.Now let's go over the steps for deep palpation, which permits assessment of the internal organs and delineation of the intra-abdominal masses. Again, always start with the quadrant where the patient is not experiencing any pain. Place the flat of your hand on the abdominal wall and apply firm pressure downward and longitudinally. Keep your fingers relatively fixed on the skin and use the rolling motion. Continue watching the patient's face for the signs of pain or discomfort as you proceed. In obese patients or if voluntary muscle resistance is present, use the two-hand palpation technique. For this, place your non-dominant hand on the top of your dominant hand. Keep the lower hand relaxed and press with the fingers of the upper hand on the distal phalangeal joints of the lower hand. This way one hand produces the pressure while the other is used to feel.After these general palpation steps, let's see how to perform liver palpation. Place your right hand lateral to the rectus muscle, well below the level of percussed border of liver dullness, and orient your fingers cephalad, slightly tilted towards the midline. Ask the patient to take a deep breath. On inspiration the liver descends and its edge meets fingertips of the palpating hand. Continue moving upwards until you feel the liver edge, which is usually a few cm below the right costal margin. Note the edge's texture and regularity. When your fingers meet the liver edge, slightly reduce the pressure on the abdominal wall while the patient is still taking a deep breath in. This maneuver allows the examiner to feel anterior liver surface as it slips under the finger pads. Make a note of the consistency of the liver surface. For bimanual liver palpation, place the left hand posteriorly at the level of the two lower ribs and gently press upward to elevate the liver into a more accessible position. Ask the patient to take a deep breath and perform palpation with the right hand as demonstrated previously. Sometimes, the liver is not palpable by these standard techniques and therefore a different maneuver like "hooking" can prove to be helpful. To perform this technique, place your flexed fingers over the edge of costal margin. Ask the patient to take a deep breath and try to feel the liver edge as you press downward and upward, towards the patient's head.Next, perform spleen palpation. A normal size spleen is rarely palpable. However, if the spleen is significantly enlarged, it displaces the stomach and expands downward below the rib cage and medially across the abdomen, and might be felt as low as at the left lower quadrant. In order to detect enlarged spleen, request the patient to take a deep breath and starting in left lower quadrant, move your fingers slightly up with each inspiration and expiration. Palpate pressing down and towards the patient's head and then releasing, in the same motion as for palpating of the lower edge of the liver. If the spleen is not felt, repeat the exam with patient lying on their right side. Some examiners use the bimanual spleen palpation technique, during which the palpation is performed with the right hand, while the left the hand is placed behind the left rib cage, and is pressed on the ribs and soft tissues upwards. Lastly, palpate to detect enlarged kidneys. Ask the patient to take a deep breath, keep your left hand positioned at the costophrenic angle and palpate with your right hand pressing forward. Attempt to capture the kidney between your hands, or at least feel it with your upper hand. If you feel the kidney on inspiration, ask the patient to exhale deeply and hold their breath for a moment. You might feel the kidney moving back to its expiratory position. Repeat the maneuver on the left side. At the end of the exam, thank the patient for their cooperation.You've just watched the JoVE Clinical Skills video on abdominal palpation. In this presentation, we reviewed the types of palpation techniques useful in evaluation of various abdominal structures. This part of physical diagnosis is especially informative when evaluating a patient presenting abdominal pain, as it provides insight into localization, cause, and severity of the problem. As always, thanks for watching!

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Clinical Skills

Physical Examinations II

abdominal palpation for organ and pain assessment

Abdominal palpation helps clinicians check for tenderness, enlarged organs, and tumors. It also supports a broader abdominal exam by adding hands-on information about where a problem may be and how severe it might be.

When performed correctly, palpation can assess large, relatively superficial organs. With skill, it can also give clues about smaller and deeper structures. The amount of information gained can vary with the patient's body build. For example, obesity can make it harder to feel internal organs, so additional maneuvers may be needed.

The focus of palpation is guided by the history and by other parts of the abdominal exam. It helps connect those findings and supports the next diagnostic steps.

Abdominal Palpation for Organ and Pain Assessment

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This collection is a specialized edition featuring methodologies and procedures associated with more sensitive and comprehensive physical exams such as HEENT exams, abdominal exams, and  pelvic exams.

Learn how abdominal palpation helps identify tenderness, organ enlargement, and tumors, and why body build and exam findings guide the next steps.

Abdominal Palpation for Organ and Pain Assessment | JoVE K12

Alex Goldfarb

Beth Israel Deaconess Medical Center

Overview

Types of Abdominal Palpation

Light Palpation

Deep Palpation

Summary

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detecting-environmental-microorganisms-with-polymerase-chain-reaction

Detecting Environmental Microorganisms with the Polymerase Chain Reaction and Gel Electrophoresis

Source: Laboratories of Dr. Ian Pepper and Dr. Charles Gerba - Arizona University
Demonstrating Author: Bradley Schmitz
Polymerase chain reaction (PCR) is ...

Gel Purification

Gel purification is used to recover DNA fragments after electrophoretic separation. DNA recovery from an agarose gel includes three basic steps: binding, ...

Detecting Reactive Oxygen Species

Reactive oxygen species are chemically active, oxygen-derived molecules capable of oxidizing other molecules. Because of their reactive nature, there are ...

Gene Silencing with Morpholinos

Morpholino-mediated gene silencing is a common technique used to study roles of specific genes during development. Morpholinos inhibit gene expression by ...

development-and-reproduction-of-the-laboratory-mouse

Development and Reproduction of the Laboratory Mouse

Successful breeding of the laboratory mouse (Mus musculus) is critical to the establishment and maintenance of a productive animal colony. Additionally, ...

Genetic Crosses

To dissect genetic processes or create organisms with novel suites of traits, scientists can perform genetic crosses, or the purposeful mating of two ...

Construct an explanation based on evidence for how the structure of DNA determines the structure of proteins which carry out the essential functions of life through systems of specialized cells.

HS-LS1-1.

Abdominal Palpation for Organ and Pain Assessment

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