How to palpate the abdominal organs during an abdominal exam

22nd Feb 2021

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.

 

How to palpate the liver

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. 

Torso and skeleton showing the location of the liver, abdomen with hand placement for liver palpation, and torso showing the inferior movement of the liver with inspiration. Illustration.

Figure 1. The liver is located in the right and left upper quadrants. When palpating the liver, place one hand inferior to the right costal margin and the left hand to support the inferior aspect of the rib cage. Have the patient breathe in deeply to cause the liver to move inferiorly. A healthy liver will not extend any further than the costal margin.   

Check out this short video clip from our Abdominal Examination Essentials Course demonstrating a normal abdominal exam without hepatomegaly: 

 

How to palpate the gallbladder

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.

Torso and skeleton showing the location of the gallbladder at the right subcostal margin, hand placement for palpating the abdomen, and abdomen with crossed-out hand placement to illustrate that the gallbladder is not normally palpable. Illustration.

Figure 2. The gallbladder is located in the right upper quadrant at the subcostal margin. To palpate, place one hand inferior to the right costal margin and the left hand to support the inferior aspect of the rib cage. A healthy gallbladder is not normally palpable.

 

Clickable call to action, "Start learning for free", with direct link to sign up for a free Medmastery trial account.

 

How to palpate the spleen 

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. 

Torso and skeleton showing the location of the spleen, abdomen with hand placement for spleen palpation, and torso showing patient taking a deep breath during spleen palpation. Illustration.

Figure 3. The spleen is located in the left upper quadrant. To palpate it, place your left hand just inferior to the left costal margin and place the right under the inferior rib cage for support. Palpate with deep pressure as the patient takes a deep breath.

In this video from our Abdominal Examination Essentials Course, the examiner is palpating along the left costal margin to palpate the spleen: 

 

How to palpate the stomach, pancreas, and duodenum 

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. 

Abdomen with epigastric region highlighted and a list of palpable abdominal organs in this region including the stomach, pancreas, and duodenum. Illustration.

Figure 4. In the epigastric region, organs that can be palpated include the stomach, pancreas, and duodenum. 

Check out this video clip from our Abdominal Examination Essentials Course for a demonstration of how to palpate the epigastrium region:

 

How to palpate the kidneys 

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 12th 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 12th rib and the ASIS). 

Skeleton showing the location of the kidneys. Horizontal section of the abdomen showing the kidneys in the retroperitoneal space. Abdomen with hand placement for kidney palpation. Illustration.

Figure 5. The kidneys are located in the right and left upper quadrants just inferior to the 12th rib in the retroperitoneal space. To palpate the kidneys, place one hand posteriorly to elevate the flank. Using the other hand, palpate between the anterior and midaxillary lines. 

This short video from our Abdominal Examination Essentials Course provides a demonstration of how to palpate the kidneys: 

 

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. 

To see a demonstration of how to tap the costovertebral angles to assess for kidney pain, check out this video from our Abdominal Examination Essentials Course: 

 

That’s it for now. If you want to improve your understanding of key concepts in medicine, and improve your clinical skills, make sure to register for a free trial account, which will give you access to free videos and downloads. We’ll help you make the right decisions for yourself and your patients.

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