Note if the abdomen is distended by fluid or gas. The presence of fluid can be confirmed by demonstrating shifting dullness: percuss,or tap, first with the patient lying supine-flat on their back; then ask the patient to lie on one side and percuss again. If fluid is present, the dull note heard on percussion moves. Palpate each region,feeling for tenderness -pain when touched, or masses -palpable enlargement of tissue. Note also any guarding or rigidity,shown by contraction of the abdominal muscles. Guarding may be due to tenderness or anxiety and can be reduced if the patient is persuaded to relax. Rigidity, however, is constant and is due to peritoneal irritation.Rebound tenderness is pain when the palpating hand is suddenly removed. It is a sign of peritonitis. Listen for bowel sounds.
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