 The abdominal examination is always important to go through the phases of inspection per patient, which is done either light and then deep, then percussion, then escultation. On inspection, the contours of the abdomen will have to be noted. In that way, is the abdomen flat, scaphoid or protuberant with a fatty apron? The hair distribution is also important. The usual female hair distribution does not extend to the abdomen. But in the presence of female escultation, you will find extension of the pubic hair on the abdomen extending all the way to the umbilicus or beyond. Now, does the abdomen move well with respiration? If it does, then most probably there is no irritation in the abdominal cavity. If there is limitation of movement, then there is likely to be an inflammatory process going on. For instance, the peritonitis or a large hemoperitonium may be present. The abdomen is also looked at for the presence of scars and scarification marks. Now, surgical scars are very important because if the patient needs surgery, one may have to go through the same area or avoid it altogether. And it's also important that one finds out the reason for the surgery and the findings. But it may all have a bearing on the current illness that the patient has brought to hospital. Now, scarification marks. In this part of the world, where people may treat chronic pain with scarification, it's also important to look out for these. Because this may give a good indication as to the chronicity of the pain that the patient may present with. For instance, in sickle cell patients, you may find scarification marks all over the hypochondrium, sometimes extending all the way down and occasionally in the left hypochondrium. And this may indicate that there has been a lot of pain for a long time in these particular areas. And in fact, sickle cell disease in certain areas may have this sign appearing. So one has to take a very good note of that. One proceeds to do the per-patient now. But before starting, the examiner will have to find out from the patient if there is any side of pain so that that area can be examined last. And with the per-patient, initially we start with the light per-patient where we have to move through all the nine different regions of the abdomen, starting from one hyaluronic ulcer to the other. Whether there are masses or not, one should be able to per-pay them on the light per-patient. Now, deep per-patient also ensues. And with the deep per-patient, one has to examine the liver, the spleen. Under normal circumstances, the spleen, when it's enlarged, moves across the abdomen from the left hypochondrium towards the right area ulcer. Now, in the presence of such a mass, it's impossible for it to move in that direction so it tends to move or it's deviated towards the left. So, we shall start looking for it from the left area ulcer. And then the kidneys for any enlargement. And especially with the examination of the liver, this is amply demonstrated in the abdominal examination by the physicians and surgeons. After the examination for organ enlargement, one then proceeds to examine for any abdominal masses, especially masses arising out of the pelvis. And in that case, one starts the per-patient gently from the zephyrstena area, gently down to the top of the mass. If it's the uterus to the fundus of the uterus. And then one can take the measurements from that point to the symphysis pelvis. That gives the longitudinal dimension. And then the lateral dimension or transverse dimension will be given when measured from the two sides. The examination proceeds. One has to then look at the examine or puppet the size of the uterus for whether it's well defined or not. And then also the surface. Is it smooth or nodular? Then also is it mobile in the transverse plane and in the longitudinal plane? With enlarged uterus, usually there is free movement in the transverse plane. But then movement is limited in the longitudinal plane. One also proceeds to find out whether one can get below the mass or not. And again it's also important to find out if the mass actually is attached to the skin by pinching the skin. Or by asking the patient to lift her body up to tense the retus abdominis muscles. One can also tell whether the mass is in the anterior abdominal wall or is actually located within the abdominal cavity proper. One has to note that the main causes of abdominal distension in the gynecological patient may be as follows. Presence of fluid. That is acitis or hemopyrtonium or PAS. Denoting acitis or raptured abdominal viscose for hemopyrtonium or the presence of pyretonitis for the PAS. Now feces may also do the same. So in the case of constipation one may find the abdomen distended. Presence of phytos. Denoting intestinal obstruction. Presence of fibroid. In other words presence of fibroids or any other abdominal masses. Presence of phytos meaning pregnancy and then fat. And this constitutes the six Fs in abdominal distension. Now after this one proceeds to do the percussion. And the percussion in the presence of abdominal masses want to find out whether there is free fluid or acitis. And in the presence of at least 500 ml of acetic fluid one should be able to elicit the shifting doneness. And how is this done? Starting the percussion from the midline above the mass. Then one proceeds gently percussing along to the flank. And if doneness occurs then the patient is asked to turn with the sight of the doneness still up. Then one proceeds to percuss again and if the doneness has disappeared then most probably there is free fluid in the abdomen. In the presence of gross acitis one may elicit the other side. And that's the fluid thrill. And in this particular case the examiner may ask an assistant to place his hands longitudinally in the midline and press it down a little. And the examiner places one hand flat on the abdomen and the flank. And then with the fingers of the second hand flicks on the abdomen. And if there is free fluid within the movement is blocked along the abdominal line. Waves or vibrations are blocked along the abdominal line by the assistant's hand. But if there is free fluid the vibration is transmitted through the fluid to the receiving hand on the other side. And that may impact the feeling of the pairing of a cut which means that there is free fluid in the abdomen. The percussion the mass that is found if it is cystic is very important also to characterize it. Because one has to differentiate between a cystic mass and flank acitis. In the case of acitis the findings have been described already but in the case of ovarian cyst the doneness is found in the midline. Or in the middle of the abdomen. And then since the intestines are displaced to the flanks that is where the resonance or timpani occurs. With the central area being more dull to percussion. Then one may ascultate the abdomen especially post surgical patients and so on. Or when pretonitis is suspected. And one listens to the bow sounds for their presence and how frequent they are. And in the presence of masses especially when vascular masses are suspected like an aneurysm of the yorta. One may then listen to the mass for bruit. And that's very very important.