8.10 : Assessment of the Abdomen III: Palpation

Palpation is a crucial tactile examination method for assessing abdominal organs and detecting conditions like tenderness, distention, masses, or fluid. It involves both light and deep palpation techniques, each serving specific diagnostic purposes. Light palpation helps identify tenderness and other surface-level indicators, while deep palpation locates and assess abdominal masses and organ boundaries. A skilled professional can gather valuable insights through palpation, including evaluating the liver and spleen, identifying abnormalities, and recognizing potential signs of inflammation or enlargement that may require further evaluation.

Palpation

Palpation is a tactile examination method used to assess the abdominal organs and detect tenderness, distention, masses, or fluid. It begins with light palpation, which aids in detecting tenderness, cutaneous hypersensitivity, muscular resistance, and swelling. Deep palpation, however, is employed to delineate abdominal organs and detect masses.

For deep palpation, the palmar surfaces of the fingers press more deeply into all quadrants of the abdomen, noting the location, size, and shape of any masses, as well as the presence of tenderness. The two-hand method is another approach for deep abdominal palpation, where one hand is placed over the other, applying pressure to the fingers of the bottom hand to feel for organs and masses.

Rebound tenderness, indicated by pain upon withdrawal of the palpating fingers, suggests peritoneal inflammation and should be evaluated by an experienced practitioner due to the potential for inducing pain and severe muscle spasms.

The liver and spleen are commonly assessed during palpation. For the liver, the patient's right eleventh and twelfth ribs are supported while the right hand presses in and up on the patient's right abdomen. The liver edge should feel firm, sharp, and smooth during inspiration. Any deviation from this could indicate a problem.

To palpate the spleen, provide support to the patient's left lower rib cage and exert forward pressure while simultaneously applying inward pressure towards the spleen using the left hand positioned below the left costal margin. A normal spleen is typically non-palpable; however it can be felt if enlarged.