Light Palpation. Feeling the abdomen gently is especially helpful in identifying abdominal tenderness, muscular resistance, and some superficial organs and masses. It also serves to reassure and relax the patient.
Keeping your hand and forearm on a horizontal plane, with fingers together and flat on the abdominal surface, palpate the abdomen with a light, gentle, dipping motion. When moving your hand from place to place, raise it just off the skin. Moving smoothly, feel in all quadrants.
Identify any superficial organs or masses and any area of tenderness or increased resistance to your hand. If resistance is present, try to distinguish voluntary guarding from involuntary muscular spasm. To do this:
■ Try all the relaxing methods you know (see p. 332).
Involuntary rigidity (muscular spasm) typically persists despite these maneuvers. It indicates peritoneal inflammation.
■ Ask the patient to mouth-breathe with jaw dropped open.
Voluntary guarding usually decreases with these maneuvers.
Deep Palpation. This is usually required to delineate abdominal masses. Again using the palmar surfaces of your fingers, feel in all four quadrants. Identify any masses and note their location, size, shape, consistency, tenderness, pulsations, and any mobility with respiration or with the examining hand. Correlate your palpable findings with their percussion notes.
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