Demonstrating the essentials of abdominal palpation

Palpation of the abdomen is the fourth component of the abdominal exam—and one of the most important. In this video, from our Abdominal Examination Essentials course, you'll learn how to build trust with your patient in pain as well as the proper hand placement for light and deep palpation.

Performing a great abdominal exam is a vital aspect of clinical practice. In this course, you’ll learn special techniques for evaluating the abdomen and how to correlate exam findings with relevant anatomy. You’ll learn the differential diagnoses associated with different regions of the abdomen and confidently refer symptomatic patients for further testing or therapeutic interventions.

Palpation of the abdomen is to touch, or to feel the abdomen with one's hands. And is the fourth component of the abdominal exam. The goal of palpation is to detect any tenderness, masses and, or organomegaly. Generally, there are two types of palpation. Light palpation, depresses the abdomen to a depth of about one centimeter, 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 four to five centimeters. It is often performed second and is used to detect masses and organomegaly. If a patient has tenderness with light palpation, they will likely have it with deep palpation, as well. Occasionally deep palpation can detect tenderness that light palpation did not.

The technique to perform palpation is straightforward. Wash your hands and warm them up by using water, so they are warm when they touch the patient's skin. Communicate with the patient and ask them to tell you where the most painful region is during palpation. Ask them to use one finger, and point to where the pain is the worst. Palpate the most painful region last.

This technique helps build trust with the patient, and allows for complete abdominal exam prior to eliciting pain. Proceed with light palpation. Perform this by either a one-handed or two-handed technique. In the one-handed technique, take the finger pad of your dominant hand and place them directly on the abdomen.

Start in the right upper quadrant and move systematically through the quadrants, or regions. Demonstrated here is the one-handed technique, for light palpation. The examiner starts in the right upper quadrant and proceeds to the left upper quadrant, left lower quadrant, then the right lower quadrant. Light palpation gently depresses the abdomen down to about one centimeter.

After completion of light palpation, then proceed to deep palpation in all four quadrants, down to a depth as deep as four to five centimeters. Demonstrated here is deep palpation, which is used to detect masses or organomegaly. As previously mentioned, the exam can be performed with a two-handed technique, as well. Use the upper hand to apply a firm and steady pressure, use the lower hand to feel.

This technique is particularly helpful if you are evaluating a mass. It can also combine both light, and deep palpation. Demonstrated here is the two-handed technique with light palpation, immediately followed by deep palpation in the right upper quadrant. This is continued systematically throughout the quadrant, and completes the exam with palpation of each flank.