Procedure
- Place the hand on the abdomen as described in the section on superficial palpation
- Ensure that the abdominal muscles are as relaxed as possible
- Gradually apply more pressure and make small vertical movements with the flats of the fingers, pushing gently into the abdomen
- To palpate deeper, the non-dominant hand can be placed on top of the dominant hand with the finger tips at the level of the distal interphalangeal joints
[Figure 21] - Distract the patient and palpate deeper on each expiration
- Palpate the entire abdomen
- Lastly, palpate the site of pain
- Check for any masses and palpation tenderness each time you press on the abdomen
Figure 21
Focus points
- Determine where deep palpation is painful and record the perimeters of the tender areas found at palpation.
- If a mass is palpable, determine whether there is a possibility of a ‘false’ tumour, such as a gravid uterus, a full urinary bladder, or intestines filled with compacted faeces.
- It is sometimes difficult to determine whether the mass felt is located in the abdominal wall or abdominal cavity. How to differentiate between these two cases is described in the previous paragraph under ‘superficial palpation’.
- Assess a pathological mass based on the following aspects:
- location
Determine the precise location of the mass - size
Estimate the size in centimetres - shape
Describe the shape, using terms such as elongated, lobular, or round; describe the borders as accurately as possible - surface
Describe the surface as smooth or irregular and bumpy. Be aware that this can be difficult due to the interfering effects of the layer found between the palpating hand and the mass. - consistency
Describe the consistency as soft, rubbery, firm, very firm, or solid (only bone is solid) - pulsations
Differentiating between a pulsating swelling and pulsations transmitted through a mass to the abdominal wall can be very difficult in some cases. They can be differentiated as follows: place your hands flat on the abdomen on both sides of the swelling; an aneurysm will pulsate in multiple directions (expansile pulsation), whereas other disorders will cause pulsation in only one direction. - palpation tenderness.
- location