examinations:abdomen
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