Abdominal examination

Look at two things – the abdomen itself, and the patient’s face. When palpating concentrate on facial expression, not on your hand. Always start with very gentle palpation away from the area of described pain, if there is one. Heavy percussion is seldom necessary – its main value is demonstrating the physical sign to a group of students. Percussion can start gently and if the information you require is obtained, there is no need to be more vigorous.

Revise the basics of organ characteristics – you can’t get above the spleen, it moves early with respiration, and (unless very large) is not bimanually palpable, whereas a kidney is, and moves later with breathing. A liver span is useful – percuss both upper and lower borders, and measure the span, don’t guess it. A pulsatile liver is generally a good sign of cardiac disease – re-check the JVP.

A bruit may indicate a tumour or be found in cirrhosis (compression, collaterals, or hypervascularity in both), but is sometimes (10%) found in normal, particularly younger, individuals. Bruits of renovascular hypertension are more specific if both systolic and diastolic.