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

Abdominal Aortic Aneurysm

Pulsatile abdominal mass (widened aortic pulsation)

Rule in

Very helpful

Rule out

Minimally helpful

Evidence:Limited

Cholecystitis

Right-upper-quadrant tenderness

Rule in

Minimally helpful

Rule out

Somewhat helpful

Evidence:Strong

Hepatomegaly

Palpable liver edge below the right costal margin

Rule in

Somewhat helpful

Rule out

Somewhat helpful

Evidence:Strong

Intussusception

Sausage-shaped abdominal mass

Rule in

Not helpful

Rule out

Not helpful

Evidence:Limited

Pyloric Stenosis

Olive-shaped epigastric mass

Rule in

Very helpful

Rule out

—

Evidence:Strong

Sigmoid Diverticulitis

Left lower quadrant tenderness

Rule in

Very helpful

Rule out

Minimally helpful

Evidence:Limited

References

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.]
Priebe WM, DaCosta LR, Beck IT. Is epigastric tenderness a sign of peptic ulcer disease? Gastroenterology. 1982 Jan;82(1):16-19. doi:10.1016/0016-5085(82)90116-0. PMID: 7053328.
Wagner JM, McKinney WP, Carpenter JL. Does this patient have appendicitis? JAMA. 1996;276(19):1589-1594. With correction: Klovning A. JAMA. 1997;278(10):819-820, and Paulson EK, Kalady MF, Pappas TN. Suspected appendicitis. N Engl J Med. 2003;348(3):236-242 (which cites the corrected Wagner values). PMID: 8918857 (Wagner 1996); erratum PMID: 9293984 (Klovning 1997).
Laméris W, et al. A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. Dis Colon Rectum. 2010;53(6):896-904. PMID: 20485003.
Lederle FA, Simel DL. The rational clinical examination. Does this patient have abdominal aortic aneurysm? JAMA. 1999;281(1):77-82. doi:10.1001/jama.281.1.77. PMID: 9892455. Full meta-analytic results freely available via DARE summary on NCBI Bookshelf (NBK67600). Underlying primary studies: 15 asymptomatic-patient screening studies (n=2,955) plus 9 ruptured-AAA studies (n=551, Level 4 quality, inconclusive).
Hom J, Lam SHF, Delaney KM, Koos JA, Kunkov S. Vomiting, pyloric mass, and point-of-care ultrasound: diagnostic test accuracy for hypertrophic pyloric stenosis-a meta-analysis. J Emerg Med. 2023;65(5):e427-e431. doi:10.1016/j.jemermed.2023.06.001. PMID: 37722950.
Naylor CD. The rational clinical examination. Physical examination of the liver. JAMA. 1994;271(23):1859-1865. doi:10.1001/jama.271.23.1859. PMID: 8196144. Full-text-equivalent EBEM summary available free at Annals of Emergency Medicine 2005;45(5):553-555 (Seupaul & Collins). The headline LR estimates for palpable liver edge predicting hepatomegaly derive from 3 primary studies (n=1,464 total).
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.