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 overall contour and symmetry, the appearance of the umbilicus, and any scars, striae, dilated veins, rashes, or other skin changes. Look for visible masses, pulsations, or peristalsis, and observe the movement of the abdominal wall with respiration.

How to Interpret

Ascites

Bulging flanks

Rule in

Somewhat helpful

Rule out

Somewhat helpful

Evidence:Strong

Bowel Obstruction

Visible peristalsis

Rule in

Very helpfulDerived CI

Rule out

Not helpfulDerived CI

Evidence:Limited

Abdominal distension

Rule in

HelpfulDerived CI

Rule out

Somewhat helpfulDerived CI

Evidence:Limited

Cushing Syndrome

Wide purple/violaceous striae (>1 cm)

Rule in

Somewhat helpfulDerived CI

Rule out

Not helpfulDerived CI

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. PMID: 1573754
Böhner H, Yang Q, Franke C, Verreet PR, Ohmann C. Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain. Eur J Surg. 1998;164(10):777-784. doi:10.1080/110241598750005435. PMID 9840308.
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.
Lederle FA, Simel DL. The rational clinical examination. Does this patient have abdominal aortic aneurysm? JAMA. 1999;281(1):77-82. PMID: 9892455.
Parasiliti-Caprino M, Bioletto F, Ferrari M, et al. A new clinical model to estimate the pre-test probability of Cushing's syndrome: the Cushing Score. Front Endocrinol (Lausanne). 2021;12:747549. PMID: 34675882.
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.

Research last updated September 10, 2026.