Physical Exam

Abdomen Inspection

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Video coming September 2026

How to Perform

With the patient supine and the abdomen exposed from the costal margins to the pubis, inspect the abdomen from the side and from the foot of the bed. Note the contour (flat, rounded, distended, or scaphoid) and symmetry, the umbilicus, the skin (scars, striae, dilated veins, rashes), and any visible masses, pulsations, or peristalsis. Watch the abdominal wall move with respiration.

How to Interpret

Ascites

Bulging flanks — the sides of a supine abdomen protrude outward because free fluid settles into the dependent flanks while gas-filled bowel floats to the top

Rule in

Somewhat helpful

Rule out

Somewhat helpful

Evidence:Strong

Bowel Obstruction

Visible peristalsis — waves of bowel contraction seen moving across the abdominal wall, sometimes raising a transient ridge

Rule in

Very helpful

Rule out

—

Evidence:Limited

References

Williams JW Jr, Simel DL. The rational clinical examination. Does this patient have ascites? How to divine fluid in the abdomen. JAMA. 1992;267(19):2645-2648. doi:10.1001/jama.1992.03480190087038. PMID 1573754.
Taylor MR, Lalani N. Adult small bowel obstruction. Acad Emerg Med. 2013;20(6):528-544. doi:10.1111/acem.12150. PMID 23758299.
Yang PM, Chen DS. Images in clinical medicine. Caput medusae. N Engl J Med. 2005;353(21):e19. doi:10.1056/NEJMicm050651. PMID 16306514.
Dickson AP, Imrie CW. The incidence and prognosis of body wall ecchymosis in acute pancreatitis. Surg Gynecol Obstet. 1984;159(4):343-347. PMID 6237447.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.