Abdominal exam

  Q: During abdominal exam which step is preferred to be performed first? (select one)

A) Percussion 

 B) Palpation

Answer: A

Although there is no hard and fast rule in this regard, experts recommend starting an abdominal exam with gentle percussion. Palpation, particularly over the most tender area, may quickly lead to abdominal muscle guarding making further examination difficult on an unwilling patient. 

Gentle percussion will allow identifying mass or organomegaly with dullness, distended bowel with tympany, and ascites with shifting dullness. 

 If palpation is carried out first, it should be started from the quadrant with the least complaint to avoid abdominal rigidness.

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Reference:

Reuben A. Examination of the abdomen. Clin Liver Dis (Hoboken). 2016;7(6):143-150. Published 2016 Jun 28. doi:10.1002/cld.556