Inspection

Shape of the abdomen : 

A) Normal – scaphoid shape 

B) Distended – 

Causes of generalized distension (5 F’s):

•  Fat (obesity).
•  Fluid (ascites).
•  Foetus (in female of child bearing age).
•  Flatus (gastrointestinal).

1. Epigastrium (remember the structures in epigastrium):

•  Left lobe of liver (hepatoma, secondaries, liver abscess, hydatid cyst).
•  Pancreas (pancreatic pseudocyst, carcinoma of head of pancreas).
• Stomach (carcinoma of stomach, lymphoma).
• Transverse colon (carcinoma of colon)
• Others: epigastric hernia, aneurysm of aorta (pulsating mass).

2. Right hypochondrium:

•  Hepatic mass (hepatoma, secondaries, liver abscess, polycystic liver, hydatid cyst).
•  Gall bladder (carcinoma, mucocoele, empyema, carcinoma of head of pancreas).
•  Mass in hepatic flexure or right side of transverse colon (carcinoma colon).

3. Left hypochondrium:

•  Splenomegaly (due to any cause).
•  Renal mass and suprarenal mass.
• Mass in splenic flexure or left side of transverse colon (carcinoma colon).
• Hydatid cyst.
•  Carcinoma of pancreas (from tail).

4. Hypogastric swelling (below the umbilicus):

•  Bladder (urinary retention).
•  In female (ovarian cyst and pregnancy).
•  Intra-abdominal malignancy.
• Lymphoma.
•  Tabes mesentericus or mesenteric cyst.
• Hydatid cyst.

C) Shrunken Abdomen : 

Causes of scaphoid abdomen (shrunken):

• Starvation.
•  Carcinoma (commonly, oesophagus and stomach).
•  Dehydration.

Umbilicus :

1) Inverted – normal 

2)Everted – umbilical hernia 

3) slit 

• a)vertical= normal 
• b) Transverse = in ascites 

4) Movement with respiration : 

• Absent in generalized peritonitis , Huge ascites , Advanced pregnancy .

Visible Peristalsis: 

1) Pyloric stenosis : from left to right 

2) Small intestinal obstruction : 

• a) Around the umbilicus 
• b) stepladder pattern 
• c) Directed above downwards 

3) Large intestinal obstruction : from Right to left 

4) normal in lean & thin person 

Others abdominal inspection : 

1)Skin : 

• a) Striae Gravidaram – Pregnancy 
• b) White purple striae – cushing syndrome 

2)Scars marks : 

• Operation ,stab injury 

3) Hair Distrubution : loss of pubic & axillary hair in cirrhosis of liver .

4) Hernial orifice : see the cough impulse .