Abdomen Examination

In a supine child, the level of the abdomen is inspected. In a healthy baby, the level of the abdomen is higher than that of the thorax. Striking findings such as this umbilical hernia are easy to see during inspection. After infancy, the level of the abdomen in a supine child is below the thorax. In a standing child, the abdomen is convex until puberty. In a greatly dehydrated child, it can be concave, even in a standing position. The auscultation of the abdomen is the same as for an adult patient.

The auscultation should be conducted carefully and sufficiently long over all quadrants. This examination is especially important in the presence of abdominal symptoms. The child must be quiet if its abdomen is to be palpated. The abdominal walls should be as relaxed as possible by having the child draw up its legs. Together with the auscultation of the heart and lungs, this examination is done at the beginning.

A helpful trick is to distract the child, for instance by asking him to show its tongue. The younger the child, the more delicate the palpation has to be. Note whether the abdominal walls are soft or whether they are taut due to pain, that is, whether there is a muscular defense. Look for tenderness and tumoral masses. Are there any hernias? When palpating the abdominal organs, the doctor should position himself opposite the organ to be examined. The liver is therefore examined from the left. Palpation begins at the pubic symphysis.

Otherwise a huge liver may easily be missed. The palpation is done with all the fingers of one hand exerting gentle pressure. The second hand may be used for better guidance. The margin itself should be carefully palpated to see whether it is sharp or rounded. The liver is also palpated for consistency and the shape of its surface as well as for tenderness. But the size of the liver is the most important factor. In the medoclavicular line we measure the distance between the costal margin and the palpated lower margin of the liver.

The size is noted in centimeters. In a baby, a liver which can be palpated two centimeters under the costal margin is still physiologically acceptable. In order to examine a young child's spleen, the doctor should stand to the right of the child. Spleenic palpation also begins near the pubic symphysis, so a grossly enlarged spleen will be easily noted. Palpation remains restricted to the surface. The examiner cups the lowest part of the thorax with his left hand while palpating with his right hand towards the costal margin. Normally only the spleenic pole can be palpated. It does not reach beyond the costal margin.

The spleen moves with every deep breath enabling the examiner to feel the spleen better and to make a clearer distinction from other structures such as the kidneys. The aspects of the spleen to be described are its size, its consistency, its surface, and any possible tenderness. If the spleen is palpable beyond the costal margin it is measured lengthwise and the distance between its palpable margin and the costal margin is noted in centimeters. The kidneys are not easily accessible to palpation. Therefore it has to be done with both hands.

While one hand lies flat on the abdomen, the other one palpates the kidneys from the back.

Resistance and possible tenderness are noted. Tenderness may also be tested by tapping on the kidneys from the back as shown here.