Abdominal inspection !

Exam technique

Looking at the abdomen in good light before touching it: shape, skin, scars, veins, movements and hernias.

Updated 2026-11-01

See it in 3D: Rectus abdominis · Linea alba · Abdominal aorta

What it is

Inspection is the first stage of the abdominal exam and comes before you touch the patient. In the abdomen the order is inspection, auscultation, percussion and palpation: you listen before you percuss and palpate because handling the abdomen can change bowel sounds, and anything painful is left until last. Careful inspection reveals distension, scars that explain adhesions, collateral veins, hernias or bruising that change the diagnosis.

Landmark anatomy

The linea alba is the tendinous midline raphe between the two rectus muscles; defects in it cause epigastric hernias and separation of the recti (diastasis).
The umbilicus is a fibrous scar in the linea alba: a weak spot for hernias and the point where paraumbilical veins dilate in portal hypertension.
The abdominal aorta runs just left of the midline and divides at about the level of the umbilicus; its pulse may be visible in the epigastrium of thin people.

Technique, step by step

Explain the exam, ask permission, wash hands and ensure privacy; offer a chaperone if wished.
Patient supine with a pillow under the head, arms at the sides and knees slightly flexed; bladder emptied if possible.
Uncover from the xiphoid to the pubic symphysis in good light; the examiner stands on the right.
Note the shape: flat, rounded, scaphoid or distended; symmetry and any localized bulge.
Check the skin: scars, striae, bruising, jaundice, lesions and visible veins; note the direction of venous flow if collaterals are present.
Look at the umbilicus (position, eversion, color) and the midline.
Crouch to the level of the abdomen and look tangentially: visible peristalsis, pulsations and breathing movement.
Ask the patient to cough, then to lift the head off the pillow, to reveal hernias or a rectus diastasis.

Abnormal findings

Generalized distension: gas from obstruction or ileus, fluid (ascites), obesity, a large mass or pregnancy.
Scaphoid abdomen: malnutrition or cachexia.
Visible waves of peristalsis: bowel obstruction (may also be seen in very thin people).
Pulsatile, expansile mass in the epigastrium or umbilical region: suspect an abdominal aortic aneurysm.
Periumbilical bruising (Cullen) or flank bruising (Grey Turner): retroperitoneal or intraperitoneal bleeding.
Wide purple striae: excess cortisol; silvery white striae: past stretching (pregnancy, obesity).

Common errors

Inspecting in poor light or with the abdomen half covered: hernias and bruising are missed.
Skipping inspection and starting with palpation: information is lost and pain comes too early.
Not looking at the flanks and groins, where Grey Turner sign and hernias appear.

Test yourself

Think of the answer, then tap the question to see it.

What is the order of the abdominal exam, and why?

Inspection, auscultation, percussion and palpation: you listen before touching because percussion and palpation can change bowel sounds, and painful steps come last.

What do dilated veins radiating from the umbilicus suggest?

Portosystemic collateral circulation (caput medusae), typical of portal hypertension.

Why ask the patient to lift the head during inspection?

Contracting the rectus muscles brings out abdominal wall hernias or a rectus diastasis in the midline.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Evaluation of the Gastrointestinal Patient - Gastroenterology - Merck Manual Professional Edition (Merck & Co., Inc., 2025); Abdominal examination (Wikipedia, 2026); Evaluation of the Patient With a Liver Disorder - Merck Manual Professional Edition (Merck & Co., Inc., 2025).

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Representative model, for educational purposes only.