Renal Bruit Physical Finding

Starting from your usual standing position at the right side of the bed, inspect the abdomen. As you look at the contour of the abdomen and watch for peristalsis, it is helpful to sit or bend down so that you can view the abdomen tangentially.

Dilated Veins Abdomen

Note:

Scars. Describe or diagram their location.

Striae. Old silver striae or stretch marks, as illustrated above, are normal.

Dilated veins. A few small veins may be visible normally. Rashes and lesions

■ The umbilicus. Observe its contour and location, and any signs of inflammation or hernia

■ The contour of the abdomen

Is it flat, rounded, protuberant, or scaphoid (markedly concave or hollowed)?

Do the flanks bulge or are there any local bulges? Include in this survey the inguinal and femoral areas.

Is the abdomen symmetric?

Are there visible organs or masses? Look for an enlarged liver or spleen that has descended below the rib cage.

Pink-purple striae of Cushing's syndrome

Dilated veins of hepatic cirrhosis or of inferior vena cava obstruction

See Table 9-8, Localized Bulges in the Abdominal Wall (p. 360).

See Table 9-9, Protuberant Abdomens (p. 361).

Bulging flanks of ascites; suprapubic bulge of a distended bladder or pregnant uterus; hernias

Asymmetry due to an enlarged organ or mass

Lower abdominal mass of an ovarian or a uterine tumor

■ Peristalsis. Observe for several minutes if you suspect intestinal obstruction. Peristalsis may be visible normally in very thin people.

■ Pulsations. The normal aortic pulsation is frequently visible in the epigastrium.

Increased peristaltic waves of intestinal obstruction

Increased pulsation of an aortic aneurysm or of increased pulse pressure

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