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surface landmarks

1. borders of abdominal cavity
2. abdominal muscles

internal anatomy: hollow

1. stomach
2. GB
3. small intestine
4. colon
5. bladder

health history questions

• Appetite
• Dysphagia
• Food intolerance
• Abdominal pain
• Nausea/vomiting
• Bowel habits
• Abdominal history
• Medications
• Nutrition

GI: routine techniques (general steps) - 6

• Observe (general behavior & position)
• Inspect for skin color, surface characteristics, contour, surface movement
• Auscultate (BS & vascular sounds)
• Palpate (light then deep)
• Percuss CVA prn
• Special techniques prn (rebound tenderness, McBurney's, iliopsoas, obturator)

Inspection (6)

• Contour
• Symmetry
• Umbilicus
• Skin
• Pulsation or surface movement
• Hair distribution


• Bowel sounds
• Vascular sounds (bruits) - aorta, renal, iliac, femoral

percuss (steps)

• General tympany
• Liver span
- Usual technique
- Scratch test
• Splenic dullness
• Costovertebral angle tenderness
• Special procedures
- Fluid wave
- Shifting dullness

percuss: tones

1. percuss (indirect) all quadrants
- develop routine to ensure all areas covered
- percuss for tympany & dullness
2. Tympany = most common tone due to presence of gas
- suprapubic area → dull when bladder is distended


low-pitched note heard on percussion of a hollow organ such as the stomach

percuss: liver

-Right midclavicular line
• Below umbilicus, percuss upward (tympany to dullness)
• Over lung, percuss downward (resonance to dullness)
• Distance between two lines = liver span (2.5 inches/6‐12 cm)

McBurney's sign

• test for appendicitis

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