Examination of the abdomen

When the doctor has finished examining the chest, he turns to the abdomen. An inspection is also started at the same time. During this inspection, the examiner looks for scars that could indicate surgery, vein markings and, if necessary, a tight abdominal wall.

Then the intestine is first listened to with a stethoscope, paying particular attention to intestinal sounds. The abdomen is then palpated. During the palpation, attention is paid to the patient’s resistance, defensive tension and signs of pain.

The location of the pain and the defence tension is indicative of the disease. For example, to rule out free air in the abdominal cavity, the doctor places his fingers on the patient’s abdomen and then taps his fingers with his free hand to assess the sound quality of the abdomen. This examination is also called percussion.

The examination of the intestine is followed by an examination of the internal organs in the abdominal cavity. First the liver borders below the right costal arch are determined. To do this, the patient is asked to take a deep breath while the doctor places his hands under the costal arch and thus palpates the edge of the liver.

Another possibility is the so-called scratch auscultation of the liver. The stethoscope is placed on the xiphoid process between the costal arches, while at the same time the fingernail is moved along the liver. The spleen and gall bladder are then examined.

This examination is only noticeable if the organs are painful or palpable. For this examination, the doctor makes an abutment with his hand while palpating the spleen with the other. The kidneys are examined in a similar way.

This examination is also conspicuous if the kidneys are painful. In addition, the kidneys are examined for knocking pain. To do this, the doctor taps both kidneys once.

A positive result can be an indication of pyelonephritis (inflammation of the renal pelvis). Depending on the patient’s symptoms, additional examinations indicating appendicitis (inflammation of the appendix) are also carried out. Here the doctor asks the patient to lie on his back.

The patient should then lift the right leg against a resistance. In case of pain this so-called psoastest is positive. In addition, the physician will test the painfulness of the McBourneypoint, which is located halfway between the navel and the anterior upper tip of the right hip bone. Furthermore, the lancet point is tested, which is located on the connecting line between the two front upper tips of the hip bone after one third on the right side.