- patient or assistant places ulnar aspect of hands firm on abdomen midline

- examiner uses one hand to palpate flank

examiner's opposite hand sharply strikes other flank

- palpate deeply in RLQ with fingers perpendicular to the abdomen

- press fingers firmly and hold ~3 seconds and quickly release fingers

- ask pt about presence and location of pain

- palpate deeply in LLQ

- ask pt if pain is felt in RLQ

- Places hands on patient’s right thigh, just above knee

- Asks patient to raise leg against resistance

- Asks patient about presence and location of pain

- Flexes patient’s right hip and knee

- Rotates leg internally

- Asks patient about presence and location of pain

- Picks up skin on abdominal wall with thumb and index finger

- Repeats at several points on abdominal wall

- Asks patient about presence and location of pain

- Use fist to percuss in RUQ for liver tenderness

- Palpates deeply in RUQ liver edge

- Asks patient to take a deep breath

- Notes degree of tenderness

- examine both sides

- use fist percussion technique (ulnar side) with appropriate pressure

- Patient is supine on table

- Ask patient to raise head and shoulders off table

- Watch the patient’s abdomen for hernia appearance

- patient is supine on table

- Patient asked to raise head and shoulders off the table

- VERBALIZE: if mass is intra-abdominal, the mass will disappear

- Patient is supine on table with head of bed at 45°

- Observe jugular pulsations during quiet respirations (this is the baseline JVP)

- Apply gentle pressure over the RUQ for 10-60 seconds

- Observe the JVP again

- VERBALIZE: increase of the JVP by >3 cm is a positive test