A mass of the abdominal wall will become more prominent with tensing of the abdominal wall musculature, whereas an intra-abdominal mass will become less prominent or disappear. It is important to differentiate abdominal wall from intra-abdominal masses. This should be performed from several angles.
Next, the abdomen should be inspected for masses. In addition to these large dilated veins, note should be made of any spider angiomas of the abdominal wall skin. Obstruction of the inferior vena cava will cause reversal of flow in the lower abdomen. Above the umbilicus, blood flow is normally upward below the umbilicus, it is normally downward. The procedure is then repeated, but the opposite finger is removed and the vein again checked for filling. A finger is removed from one end and the vein is watched for filling. The fingertips are then slid apart, maintaining compression, producing an empty venous segment between the fingers. This is performed by placing the tips of the index fingers together, compressing a visible vein. The skin of the abdomen should also be checked carefully for engorged veins in the abdominal wall and the direction of blood flow in these veins. Careful note of surgical scars should be made and correlated with the patient's recollection of previous operations. The skin should be inspected for striae, or "stretch marks," and surgical scars. Any areas of discoloration should be noted, such as the bluish discoloration of the umbilicus (Cullen's sign) or flanks (Grey Turner's sign). The abdominal wall skin should be inspected carefully for abnormalities. Similarly, the flanks should be checked for any bulging. The contour should be checked carefully for distention and note made as to whether any distention is generalized or localized to a portion of the abdomen. Good lighting is essential, and it is helpful to have tangential lighting available, for this can create subtle shadows of abdominal wall masses.įirst, the general contour of the entire abdominal wall is observed.
The patient's arms should be at the sides and not folded behind the head, as this tenses the abdominal wall. The entire abdominal wall must be examined and drapes should be positioned accordingly. The head and knees should be supported with small pillows or folded sheets for comfort and to relax the abdominal wall musculature. The abdomen is inspected by positioning the patient supine on an examining table or bed.
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