The 3 Critical Components of the Abdominal Exam

Published: 21st May 2010
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Let's face it; most clinically important infections occur in the lungs or urine. 9 out of 10 infections are from wind or water. We have to be concerned with the abdomen and the cerebral spinal fluid as that 1 out of 10 cause for infection. Let's talk about the abdomen.

Physical exam of the abdomen has to do with guarding, rebound and rigidity. Now, a little bit about pathophysiology of the abdomen. You have all your intestines, held in place by your peritoneum. Now, your peritoneum, when it becomes irritated, clamps down the muscle structures. You must gain experience in the abdominal evaluation but examining a number of patients . If you know a patient has a surgical abdomen, even if it's not your patient, go feel their abdomen.

Guarding is the response where as you examine a patient's belly, they voluntary flex their stomach muscles so you cannot examine them. If you want a good example of this, especially if your are a girl, go up to a guy in a bar and grab his biceps. Now, what a guy will typically do is he will flex his biceps voluntarily, kind of saying, 'Hey, my arm is always strong, I'm a strong guy.If a patient has a voluntary flexion of the the right lower quadrant, that is known as guarding. The constantly flexed abdomen is called rigidity. This is the abdominal muscles held in flexion. You are unable to distract the patient and get him to relax, as you can in guarding. We call this a rigid abdomen, that usually represents a surgical urgency. If you shake the peritoneum and it hurts, that represents rebound tenderness. Now, from the physical exam perspective, as I am sure you folks know, you push down on one part of the belly, you let go, and that let go vibrates the peritoneum which causes pain at the site of irritation. Another way to do this is to do a heel jar test. This is where I would approach a patient from the bedside, make a closed fist and actually strike the heel of the foot a number of times. The inflammatory response causes pain at the site of inflamed organ. From an historical perspective, this is where you would ask the patient, 'Did every bump on the car ride over cause you pain?WIth every little stimulation of the abdomen, such as hitting a little bump in the road, that is caused by rebound tenderness.


Chest pain and abdominal pan can be difficult and challenging. When evaluating a patient with abdominal pain, you need to understand the key features of the physical exam. Emergency medicine is an approach to patient care, as with abdominal pain and the patient with chest pain.

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