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Examination of the abdomen

Among the major anatomical regions of the body, the abdomen—bounded above by the thorax and below by the pelvis—is something of a paradox in terms of the accessibility of its contents, despite the fact that its anterior approach is soft and pliable when relaxed and its organs are not diminutive. Generally, the normal abdominal viscera are not detectable on physical examination, with the possible exceptions of a liver that is pushed down below the costal margin by a diaphragm that is depressed by thoracic disease (such as emphysema and scoliosis), or the pulsations of the descending aorta in an individual who is constitutionally or pathologically thin, in whom incidentally the kidneys and the inferior margin of the liver may occasionally also be felt. In contrast, in the current climate of prevalent obesity, pathologically enlarged intra-abdominal organs or fluid, or both, may not be detected at the bedside in a belly that is distended with central adiposity. The notion that organs as large as the liver, kidneys, and intestines are usually impalpable is embodied in the etymological origin of the word abdomen that is derived from the Latin abdere, meaning ‘‘to hide.’’ It is ironic that the lay term belly, derived from the Old English belg, that is, a bag, implies protuberance, distension, or swelling, as expressed graphically in the plural noun bellows and the verb to billow. Strictly speaking, the liver lies in the thorax, below the dome of the right hemidiaphragm, where it can be detected by percussion; but it has more in common anatomically and functionally with the organs of digestion and the spleen than with the lungs and the heart, which for the latter the liver provides a supportive platform.