Abdominal Examination
Common disorders to consider
| Disorder | Usual Pain site | Referred pain |
| AAA (abdo aortic aneurysm) | Central abdo and back | Back |
| appendicitis | Periumbilical to RLQ | R shoulder |
| bowel obstruction | epigastric or central | |
| cholecystitis | epigastric | R shoulder, scapula |
| diverticulitis | LLQ | |
| pancreatitis | epigastric, central | back, L shoulder |
| PID (pelvic inflam disease) | lower abdo | |
| Ectopic preg | unilateral lower abdo | shoulder tip |
Common abdominal signs
Murphy's sign - pain and tenderness under R costal margin on palpation with deep inspiration - cholecystitis
Rovsing's sign - pain in RLQ when palpating LLQ - appendicitis
McBurneys point - RLQ site ~1/3 distance from ASIS to umbilicus - appendicitis tender point
Ballances sign - percussion dullness LUQ - collection/blood suggestive of splenic rupture
Cullens sign - bluish bruising about umbilicus - seen with haemorrhagic pancreatitis
Grey Turners sign - bluish bruising about flanks - seen with haemorrhagic pancreatitis
Kehr's sign - L shoulder tip pain - seen with ruptured ectopic, splenic trauma
Pitfalls
elderly patients commonly do not show 'typical' signs and can often have significant visceral rupture and not show tenderness
typical signs associated with some diagnoses are not always present - eg. appendicits - 10% won't be febrile, bowel obstruction - 20% won't have colicky pain
Author: Dr Dylan Jenkins, Oct 2023