How to palpate the abdomen during an abdominal exam

Palpation of the abdomen involves touching or feeling the abdomen with your hands and is the fourth component of the abdominal exam. The goal of palpation is to detect any tenderness, masses, or organomegaly.

Generally, there are two types of palpation. Light palpation depresses the abdomen to a depth of about 1 cm. It is often performed first and is used to detect tenderness in a particular region or quadrant.

Deep palpation depresses the abdomen to a depth of about 4–5 cm. It is often performed second and is used to detect masses and organomegaly.

If a patient has tenderness with light palpation, they will also have tenderness with deep palpation. Occasionally, deep palpation can detect tenderness that light palpation did not uncover.

There are five steps to palpating the abdomen:

1. Wash and warm your hands so they are warm when you touch the patient’s skin.
2. Communicate with the patient and ask them to tell you where the most painful region is during palpation. Ask them to use one finger to point to where the pain is the worst, and then palpate the most painful region last. This technique helps build trust with the patient and allows for a complete abdominal exam before eliciting pain.
3. Palpate with light pressure then deep pressure.
4. Palpate all four quadrants. Start in the right upper quadrant and move systematically through the quadrants or regions. After the completion of light palpation, proceed to deep palpation in all four quadrants. Another option is to perform light palpation immediately followed by deep palpation in each quadrant before moving on to the next.
5. Use a one-handed or two-handed technique. Light and deep palpation can be performed either with a one-handed or two-handed technique. In the one-handed technique, take the finger pads of your dominant hand and place them directly on the abdomen. For a two-handed technique, use the upper hand to apply firm and steady pressure and use the lower hand to feel the abdomen. This technique is particularly helpful if you are evaluating a mass.