Palpation is the act of using touch to examine the body and is a fundamental technique in medical assessment. This non-invasive procedure allows healthcare providers to gather physical information about internal organs and structures beneath the skin. In the abdomen, palpation identifies signs of disease, such as areas of tenderness, unusual masses, or organ enlargement.
Mapping the Abdomen
Before the physical examination, the abdomen is conceptually divided into four quadrants by drawing imaginary vertical and horizontal lines that intersect at the navel. This creates a standardized “map” for communicating the precise location of findings. The quadrants are the Right Upper Quadrant (RUQ), Left Upper Quadrant (LUQ), Right Lower Quadrant (RLQ), and Left Lower Quadrant (LLQ).
The contents of these quadrants include:
- Right Upper Quadrant (RUQ): Liver, gallbladder, and portions of the pancreas, stomach, and right kidney.
- Left Upper Quadrant (LUQ): Spleen, the main part of the stomach, and portions of the liver, pancreas, and left kidney.
- Right Lower Quadrant (RLQ): Appendix, cecum, and portions of the small intestine and right reproductive organs.
- Left Lower Quadrant (LLQ): Portions of the descending and sigmoid colon, the small intestine, and the left reproductive organs.
Differentiating Palpation Techniques
The examination of the abdomen uses two distinct palpation techniques: light and deep. Light palpation is always performed first, using the finger pads to gently depress the abdominal wall only about one to two centimeters. This superficial touch assesses general tenderness, skin temperature, texture, and the presence of involuntary muscle guarding. The movement should be gentle and circular across each section of the abdomen.
Deep palpation is performed to reach the deeper abdominal organs and structures. This technique requires applying firm, steady pressure to a depth of approximately four to five centimeters. A two-handed technique is often employed, where the top hand applies pressure and the bottom hand focuses on feeling the structures beneath. Deep palpation assesses the size, shape, and consistency of organs like the liver and spleen, and detects deep-seated masses.
What Sensations to Look For
Palpation identifies abnormalities that suggest an underlying medical condition, which are used to guide further diagnostic steps. Tenderness is the objective expression of pain when the area is pressed. The examiner must note if the pain is generalized or localized, and whether it is superficial or felt only with deep pressure.
Muscle guarding is the tensing of the abdominal muscles in response to pressure. This can be voluntary, caused by anxiety, or involuntary, which is a reflex contraction suggesting underlying inflammation. Rigidity, a more severe form, is a continuous, board-like stiffness of the abdominal wall indicative of widespread inflammation of the peritoneum.
When a mass is discovered, a detailed description is necessary, including its precise location, size, and consistency (soft, firm, or hard). The mobility of the mass must also be assessed, noting if it moves with respiration or if it is fixed. Rebound tenderness is a specific sign where pain is felt when the hand is rapidly released, not when pressure is applied. This sensation reliably indicates that the peritoneum, the membrane lining the abdominal cavity, is irritated or inflamed, a condition known as peritonitis.
Critical Safety Precautions
It is important to recognize that findings from abdominal palpation are diagnostic signs used by trained professionals and are not intended for self-diagnosis. Self-examination should never be considered a substitute for a comprehensive medical evaluation and professional advice. The procedure carries risks under certain circumstances, and deep palpation is specifically contraindicated in cases of known or suspected abdominal aortic aneurysm.
Applying deep pressure is also warned against if a patient has acute appendicitis or recent abdominal surgery, as this could lead to complications. The patient’s comfort and relaxation are important for an accurate assessment. Having the patient bend their knees and communicating each step helps relax the abdominal muscles, reducing voluntary guarding and allowing for a safer examination.