Synopsis
Perform a respectful, reproducible abdominal examination; recognise peritonism, decompensated liver disease, portal hypertension and an abdominal mass; and describe physical signs as probability-changing evidence rather than diagnoses.
- Introduce yourself, confirm identity, explain the examination, obtain consent, offer a chaperone where appropriate, preserve dignity and ask about pain before positioning or exposure.
- Start at the end of the bed: distress, colour, body habitus, muscle wasting, mobility, drains, stomas, oxygen and mental state may be more important than a single abdominal sign.
- Examine hands, pulse, face, mouth, chest, abdomen, legs and cognition because chronic liver disease and systemic abdominal illness are not confined to the abdomen.
Key red flags
Involuntary guarding, rigidity, percussion tenderness, absent movement with breathing, tachycardia, hypotension, cool peripheries or altered mental state suggests perforation, ischaemia, bleeding or severe inflammation.
Investigation priorities
Record NEWS2 elements, perfusion, urine output and glucose when acute abdominal or hepatic illness is possible.
Management branches
A stable patient consents to a clinically indicated abdominal assessment.
- Introduce, identify, explain, consent and position; ask about pain, expose appropriately and preserve dignity with a chaperone where indicated.
- Assess from the end of the bed, hands, pulse, face, mouth and chest, then inspect the abdomen before gentle and deep palpation.