Percussion of the abdomen

Definition: The purpose of abdominal percussion is to assess whether the abdominal contents are solid, hollow, air or fluid-filled. With percussion you can also delineate the size of individual organs. Test procedure: To achieve good percussion sounds place your middle finger firmly flat against the abdomen and strike it with a hammer-like motion with the […]

Palpation of the spleen

Definition: The spleen is about the size of a fist and is located in the left hypochondrium beneath the rib cage usually. In normal healthy individuals the spleen is not palpable. Enlargement is a sign of abnormality. In enlargement of the spleen the organ expands along the line of the 9th rib and travels downwards […]

Palpation of liver (various techniques)

Definition:A healthy liver is not easily palpable although sometimes the liver edge can be felt in normal individuals at the peak of inspiration with the examiner’s fingertips applying pressure just below the costal margin in the right upper quadrant. Test procedure: With the patient supine and with the knees supported with a cushion (aiding abdominal […]

Palpation of kidneys

Definition: To palpate or ballot the kidneys the examiner should place one hand under the patient in the flank region and the other hand on top just below the borders of the costal margin. Test procedure: Note the kidneys cannot be palpated normally even in a slim person. To feel for the kidneys you need […]

Examination techniques for hernia

Definition: A hernia is the protrusion of an organ or structure through the abdominal wall due to some weakness or defect in the support of the abdomen. There are several types of herniae: Umbilical, Abdominal, Femoral, Direct and Indirect inguinal herniae. Test procedure: It best to observe the patient both lying supine and then standing […]

Shifting dullness

Definition: Shifting dullness test evaluates the presence of ascites or intraperitoneal fluid Test procedure: With the patient supine percuss the whole abdomen including the flanges. Note the distribution of dullness and resonance. Then place the patient on their side and wait for 30-60 seconds. Percuss the abdomen again this time systematically starting from the lower […]


Definition: The presence of an abnormal accumulation of fluid within the peritoneal cavity. Detectable when over 500ml. Contains high amount of proteins and electrolytes. Causes: Most commonly caused by obstruction in the hepatic-portal circulation in particular cirrhosis of the liver. The ascetic fluid escapes from the abdominal vessels such as the lymphatics and veins. Other […]