Alimentary (Digestive) system

Inspection of the abdomen in vertical position.

The shape of the abdomen (normal, protruding, enlarged (for example – obesity or ascites), inflated (meteorism or ascites), involve), navel (smoothed, involve, protruding), dilated collateral veins may also radiate from the umbilicus on the anterior abdominal wall («caput Medusae»), establishing the direction of the blood follow in the collaterals. Postoperative cicatrix, стрии, stretchings, pigmentation (after hot-water bottle), divergence of direct muscles of a stomach. Hernia (inguinal, femoral, umbilical, midline hernia). Percussion: wind, ascites (to specify the top level of a liquid).

Inspection of the abdomen in horizontal position. The shape of the abdomen (symmetric, protruding, sunk down, "frog", local protrusion), degree of development subcutaneous fat, easily seen peristalsis, participation in the breathing (active, weak, does not participate).

Light (superficial, tentative) palpation.

Muscular tonus of the anterior abdominal wall; the stomach soft, is painless, local tenderness, tension in the abdominal wall, presence of the muscular defense (muscle guarding, «dėfense musculaire»), swelling; symptoms of irritation of the peritoneum (Shchetkin-Blumberg symptom); tumour of the abdominal wall (site (localization), size, form, contours, consistency, tenderness), midline hernia.

Deep sliding methodical (topographical) bimanual palpation accoding to V.P.Obraztsov and N.D.Strazhesko.

Research of bodies of a belly cavity to lead (carry out) strictly consistently, in such order.

Palpation: the sigmoid, the caecum with the appendix, pars coecalis ilii, the ascending and descending colon, the stomach with its part, the transverse colon, the liver, the spleen, the duodenum, the pancreas, the kidneys: physical qualities of each of them separately: form (cylinder, тяжа etc.), size (length, width in cm), surface (smooth, tuberous), consistency (elastic, soft, flabby, firm, hard), tenderness (painless, sensitive, painful), mobility, rumbling sound.

The greater curvature of the stomach: position (on how many than cm above or lower navel), surface, consistency, mobility, morbidity; to compare to the data of definition by the splashing sound of V.P.Obraztsov.

Auscultation: bowel sounds.

Percussion of the liver:

Lines	The upper border	The lower border
right anterior axillary line
right midclavicular
right parasternal
anterior median
left parasternal

Palpation of the liver, on how many cm protrude above the costal margin on right midclavicular line, anterior median line (left lobe of liver), the form of liver edge (sharp, rounded, rough), surface (smooth, tuberous), consistency (flexible (elastic), soft, firm, hard), tenderness.

Ballottement liver at palpation in the presence of ascites.

Percussion of the spleen:

superior border anterior border

lower border.

Palpation of the spleen: on how many cm protrude above the costal margin, surface, consistency, sensitivity.

Palpation of the kidneys (in horizontal and vertical positions): shape, size and thickness of the lower pole (of right, left kidney), surface (smooth or tuberous), consistency, mobility, tenderness.