How to palpate the abdomen during an abdominal exam

5th Feb 2021

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. 

 

Why perform both light and deep abdominal palpation?

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. 

 

How to palpate the abdomen

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. 

Hands washing, hand pressing on abdomen eliciting pain, hand pressing on the abdomen with light pressure and then deep pressure, hand pressing on the right upper quadrant and moving clockwise to all four quadrants, one hand or two hands pressing on the abdomen. Illustration.

Figure 1. The five steps to palpating of the abdomen include: 1) Wash and warm your hands, 2) Communicate with the patient and palpate the most painful area last, 3) Palpate with light pressure then deep pressure, 4) Palpate all four quadrants, 5) Use a one- or two-handed technique.

Check out this short video snippet from our Abdominal Examination Essentials Course that demonstrates light palpation using a one-handed technique:

 

Here’s another short Abdominal Examination Essentials Course video that highlights how to perform deep palpation using a one-handed technique: 

Demonstrated in this Abdominal Examination Essentials Course video is the two-handed technique using light palpation immediately followed by deep palpation in each quadrant and finally the palpation of each flank:

 

 

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Recommended reading

  • de Dombal, FT. 1988. The OMGE acute abdominal pain survey. Progress report, 1986. Scand J Gastroenterol Suppl144: 35–42. PMID: 3043646
  • Jin, XW, Slomka, J, and Blixen, CE. 2002. Cultural and clinical issues in the care of Asian patients. Cleve Clin J Med69: 50, 53–54, 56–58. PMID: 11811720
  • Tseng, W-S and Streltzer, J. 2008. “Culture and clinical assessment”. In: Cultural Competence in Health Care. Boston: Springer. 
  • Wong, C. 2020. Liver fire in traditional Chinese medicine. verywellhealthhttps://www.verywellhealth.com