Palpation of abdomen structures

Principles

• Always stand on the right side of the patient(if you are right-handed)
• Get the patient to lie supine on the bed
• Ask the patient to flex the legs at knee joint
• Expose the abdomen up to the chest and below up to the inguinal canal. Ask the patient if there is any tenderness before palpating
• Ask the patient to take deep breaths. Breathe in through the nose and breath out through the mouth 
• You can request the patient to look to the other side -opposite to the side you are standing so that the patient doesn’t breath on your face
• Rub your hands together to warn them before palpating
• Always palpate the child is breathing out(expiration) 

Points to note with abdominal palpation

• Surface temperature
• Tenderness
• Consistency
• Localised/ Movable
• Pulsations
• Divarication of rectus
• The flow of direction of blood in dilated abdominal veins
• Ascites with grading

Method to palpate kidneys (Bimanual Palpation)

The two kidneys are palpated separately. It might be easier to palpate both the kidneys by standing on the right of the patient (in right-handed doctor)

• You can sit down if needed for your hands to be at the level with abdomen
• Now place your right hand over the exposed anterior abdomen at the right lumbar quadrant
• Place your left hand on their back at the corresponding region
• Gently press the right hand hoping to move the kidney to hit your left hand at the back
• Now press the left hand to feel it in your right palm.
• This is the ballotment test
• You can also feel the left kidney from the left side of the patient.

Causes of palpable kidneys

Occasionally the kidney may be felt.

Unilateral Causes

• Unilateral hydronephrosis
• Wilms tumour
• Hypernephroma
• Cyst 

Bilateral causes

• Polycystic kidneys
• Bilateral hydronephrosis
• Amyloidosis