Perform the following tests if indicated/clinical suspicion:

  • Ascites
    • Fluid Wave Test
      • Have the patient hold their hand over the midline of the umbilical region, put your hands on the patient’s sides, tap with one side, check to the other for feeling the impulse sent
      • Note positive or negative fluid wave test
    • Shifting Dullness Test
      • Patient in supine position, tap from umbilicus laterally until you hear dullness; then have them rotate to their side (decubitus position) to raise that side of their body, wait a moment for the fluid to move, and see if it’s tympanic (looking for fluid in abdomen)
      • Note if shifting test is normal or abnormal
  • Appendicitis
    • Mcburney’s Point
      • McBurney’s Point is 1/3rd the distance from the ASIS to the umbilicus on the side of ASIS
      • Palpate at this point using deep palpation
      • While doing this, you look at patient’s face for signs of pain
    • Rovsing’s Sign
      • Palpate at the LLQ, and look at the patient’s face for signs of pain in RLQ
    • Psoas’ Sign
      • Ask the patient to relax their right leg and put the knee in 90 degree flexion. Press against the thigh and ask the patient to push against your hand. 
      • RLQ pain during this maneuver increases suspicion of appendicitis 
    • Obturator Sign
      • Flex the patient’s hip and knee at 90 degrees. Grasp the right leg and rotate laterally (internally rotating the hip)
      • RLQ pain increases suspicion of appendicitis 
  • Cholecystitis
    • Murphy’s Sign
      • Done to assess for a palpable gallbladder.
        • Ask patient to deeply inspire, hook right hand under the right costal margin at the MCL
          • While doing so, feel for the gallbladder and if acute pain/inspiration arrest has occurred. 
          • Pain or inspiration arrest increases suspicion of cholecystitis
          • Palpable non-tender gallbladder with mild jaundice is cancer until proven otherwise.