Physical Exam

Abdomen Palpation

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Video coming September 2026

How to Perform

With the patient supine, knees slightly flexed and arms at the sides to relax the abdominal wall, palpate all four quadrants — first lightly, assessing for tenderness, guarding, and superficial masses, then more deeply, assessing for organs and deeper masses. Watch the patient's face for discomfort throughout, and palpate any area of known pain last.

How to Interpret

Acute Cholecystitis

Right upper quadrant tenderness

Rule in

InconclusiveWide CI

Rule out

InconclusiveWide CI

Evidence:Strong

Appendicitis

Right lower quadrant tenderness

Rule in

HelpfulNo CI

Rule out

HelpfulNo CI

Evidence:Limited

Diverticulitis

Sigmoid Diverticulitis

Left lower quadrant tenderness

Rule in

Somewhat helpful

Rule out

Somewhat helpful

Evidence:Limited

Intussusception

Palpable abdominal mass

Rule in

Not helpfulDerived CI

Rule out

Not helpfulDerived CI

Evidence:Limited

Pyloric Stenosis

Olive-shaped epigastric mass

Rule in

Very helpfulDerived CI

Rule out

Somewhat helpfulDerived CI

Evidence:Strong

Urinary Retention

Palpable bladder, detecting a bladder volume of at least 400 mL

Rule in

Minimally helpful

Rule out

InconclusiveNo CI, small study

Evidence:Limited

References

Research in progress on one or more findings above; ratings may change.

Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? JAMA. 2003;289(1):80-86. doi:10.1001/jama.289.1.80. PMID: 12503981. Free DARE summary at NCBI Bookshelf NBK69792. [Published correction appears in JAMA. 2009;302(7):739.]
Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? JAMA. 2003;289(1):80-86. doi:10.1001/jama.289.1.80. PMID 12503981. Free structured abstract: DARE, NCBI Bookshelf NBK69792. [Closest work; adjudicates acute cholecystitis — §3 Condition 2.]
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