How to palpate the abdominal organs during an abdominal exam

Deep palpation helps feel for certain palpable abdominal organs—especially if they are enlarged. Organs that should be palpated during the deep exam include the liver, gallbladder, and spleen. We will also discuss techniques for palpating the stomach, pancreas, duodenum, and kidneys.

To palpate the liver, place your right hand parallel to the right costal margin, and use your left hand to support the inferior aspect of the rib cage. Provide a steady downward pressure to feel for the liver and gallbladder.

An additional tip is to have the patient take a deep breath in as you press down on the right costal margin. On inspiration, the liver will move down towards your hand. In a normal exam without hepatomegaly, the liver does not extend below the right costal margin. However, with an enlarged liver, you will feel the liver move down—essentially bumping into your hand at the right costal margin.

If an enlarged liver is detected, pay attention to the size, consistency, tenderness, and any other specific characteristics.

Palpation of the gallbladder is performed alongside palpation of the liver. It lies adjacent to the liver at the right subcostal margin. The gallbladder is usually not palpable, but it may be in a diseased state.

Normally, the spleen lies in the left upper quadrant and is quite posterior. Therefore, it is not always palpable. To palpate the spleen, place your right hand behind the patient’s inferior rib cage to support it. Then, use your left hand to palpate along the left costal margin.

Have the patient take a deep breath. During the inspiration, perform deep palpation on the inferior edge of the spleen.

The organs located in the epigastric region are the stomach, pancreas, and duodenum. These organs can be palpated with a combination of deep and light palpation. The stomach can also be palpated in the left upper quadrant or left hypochondriac region.

The kidneys are bilaterally located in the retroperitoneal space (e.g., retroperitoneum), which is the anatomical space in the abdominal cavity that lies behind the peritoneum. Specifically, the kidneys lie between the 12^th rib and the anterior superior iliac spine (ASIS). The right kidney sits slightly lower than the left due to downward displacement by the liver.

To palpate the patient’s kidneys, use one hand to elevate the flank by placing it posteriorly. This helps to shift the retroperitoneal structures anteriorly. Use the other hand to palpate the area between the anterior and midaxillary lines (e.g., between the patient’s 12^th rib and the ASIS).

What if I can’t palpate the kidneys?

Even if the kidneys cannot be palpated (because they are retroperitoneal), it is important to determine if they are tender. Have the patient sit upright and tap the costovertebral angles. Tenderness may indicate a urological source of abdominal pain.

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