abdominal exam

Q: In an abdominal examination, which is preferred to be performed first? (select one)

A) Palpation

B) Percussion 

Answer: B

In the abdominal examination, gentle percussion is preferred before palpation because patients with peritonitis may feel severe pain with even gentle palpation. Gentle percussion causes less pain, which makes further examination easier. Palpation, particularly rebound tenderness, can be agonizing for patients.

Muscular rigidity, aka "guarding," signifies local or diffuse peritonitis and is not a feature of pain originating from organs such as kidney stones or pancreatitis.

#physical-exam

References:

1. Fritz D, Weilitz PB. Abdominal Assessment. Home Healthc Now. 2016 Mar;34(3):151-5. doi: 10.1097/NHH.0000000000000364. PMID: 26925941.

2. Ferguson CM. Inspection, Auscultation, Palpation, and Percussion of the Abdomen. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 93. Available from: https://www.ncbi.nlm.nih.gov/books/NBK420/

3. Mealie CA, Ali R, Manthey DE. Abdominal Exam. 2022 Oct 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29083767.