Abnormal Finding
Contour: When protuberant note the distance between umbilicus to symphysis-pubis and epigastrium. Observe the flanks. Percuss abdomen. If dull, and ascites is suspected elicit fluid thrill and shifting dullness.
- Pregnancy: Umbilicus to symphysis pubis longer than umbilicus to xiphisternum. Foetal heart tones. Dull to percussion.
- Ascites: Flanks full, dull to percussion, shifting dullness, fluid thrill.(Cirrhosis)
- Obesity:
- Flatus: Resonant to percussion.(Intestinal obstruction, Ileus)
- Tumor: Asymmetry (Large Liver or Spleen, Myelofibrosis with Hepatosplenomegaly, Kidney, Pelvic organ tumors)
Skin and subcutaneous tissue
- Scars: Location and type helps identify previous surgery.
- Striae: Stretch marks indicate previous distension of abdomen.. Pink purple striae seen in Cushing's syndrome.
- Distended collateral veins: When seen identify the direction of flow both for the veins above and below umbilicus. (Portal hypertension, Caput medusae, SVC and IVC obstruction)
- Hernia
- Umbilical hernia:
- Incisional hernia:
- Linea alba hernia: Small, midline tender herniation usually in epigastrium.
- Diastasis recti: Midline ridge like bulge between rectus abdominis muscles.
Umbilicus
- Eversion: Raised intra-abdominal pressure (Ascites, Tumor)
- Hernia: (Congenital, Raised intra-abdominal pressure)
- Deviation: (Ipsilateral paralysis of Rectus abdominis)
Pulsation: Epigastric ( Aortic aneurysm)
Visible peristalsis: Exaggerated (Intestinal obstruction)
- Prominent: ( Intestinal obstruction)
- Absent: (Peritonitis)