Inspection of Abdomen

• Overall Shape of the Abdomen:

  • Start by observing the general contour. Is it flat or slightly hollowed (sometimes called scaphoid, which might hint at something like severe malnutrition or even an underlying malignancy)?

  • Or is it full? If full, is the swelling all over (generalized)? Or is it just noticeable in certain spots (localized)? Pay attention to the sides of the abdomen – if they bulge, we call that fullness in the flanks, often a sign of fluid buildup (ascites).

• The Umbilicus (Belly Button):

  • Normally, it should appear slightly drawn inward and inverted.

  • Look closely for any changes: Is it everted (pushed outwards), which can happen with fluid accumulation or a mass? Are there any small, hard bits inside (an omphalolith)? Or signs of a hernia where tissue protrudes through it?

• Abdominal Wall Movements:

  • Watch the abdomen as the patient breathes. You can often make this more obvious by shining a light across the abdomen from the side – this creates shadows that highlight movement.

  • Are the movements normal and free with respiration? Or are they absent or reduced, which could suggest inflammation or guarding?

  • Specifically, look for visible peristalsis (wave-like movements of intestines), which is usually abnormal and suggests an obstruction.

  • Also, scan for any visible pulsations, which might indicate an underlying aortic aneurysm or prominent blood vessels.

• Skin and Surface Details:

  • Examine the skin on the abdominal wall carefully.

  • Are there striae (stretch marks)? Differentiate between old, silvery ones (striae atrophicae/gravidarum) and fresh, often purple ones (purple striae), which can be a sign of Cushing's syndrome or rapid weight changes.

  • Look for any unusual pigmentation on the skin.

  • Are there any obvious scars from previous surgeries or injuries?

  • Note any localized bulges or areas where the skin appears retracted or sunken.

• Superficial Veins:

  • This is best assessed with the patient standing, if possible.

  • Look for any dilated veins on the abdominal surface.

  • If you see them, try to determine the direction of blood flow within these veins using a simple "milking" technique (press on a segment, push blood out of one end, release the other end, and see if it refills).

    • Veins flowing downwards from above might suggest an obstruction in the Superior Vena Cava (SVC).

    • Veins flowing upwards from below could point to an Inferior Vena Cava (IVC) obstruction.

    • Perhaps most relevant to GIT, look for Caput Medusae: these are prominently dilated veins radiating outwards from the umbilicus, with blood flow away from the umbilicus, a classic sign of severe portal hypertension.

    • Also check for dilated veins over the flanks or back, which might also suggest IVC obstruction.

    • Finally, look for localized dilated veins over specific areas, which could be related to inflammation or an underlying malignancy.

• Hernial Orifices & External Genitalia:

  • Always remember to briefly inspect the common areas where hernias can occur (like the inguinal and femoral regions) and the external genitalia as part of a complete abdominal inspection.