Your doctor can only examine your abdomen a limited number of times, and has to assume it is the same at other times.
You can help your abdominal pain diagnosis greatly, by filling in this detail and reducing uncertainty.
Lay down on your back, with head and shoulders propped up on pillows to improve your view. Open your mouth widely and keep it open during this examination. Take deep breaths and examine your abdomen while you are breathing out each time. These measures are to help you relax your abdominal muscles.
Push in moderately firmly all over your abdomen, and note carefully the extent of any tender areas.
Record these areas on a simple diagram, cross hatching in the areas of tenderness. Repeat the examination over a period of time, but don't delay seeking medical attention while you're doing this.
You may feel lumps and bumps, especially down the mid line. Your
pulse may be felt there, about half way down. Your doctor will be
examining you, so I'm sticking to instructions about tenderness.
To check for tenderness of your liver and gallbladder, relax your tummy, dig your fingers in under your right ribs, and breath in deeply. Did it hurt more as you breathed in?
Your liver is a large organ, marked on the surface by a triangle between your nipples and the bottom of your ribs on the right side.
You can compare doing this test on right and left sides. if it is more tender on the left, the stomach is more likely to be the tender organ.
If you have found any area of tenderness, the next step in your abdominal pain diagnosis is to determine whether it is abdominal wall or visceral (internal organ) tenderness.
Laying on your back, ensure that the spot is consistently tender
as you rub with a circular motion of your fingers, moving the skin over
the deeper structures.
Your fingers don't slide over the skin, but stay on the exact same bit of skin as they make the circles.
Compare the tenderness using the same pressure, with your abdominal muscles alternately tightened and relaxed. Tighten them by starting to lift your legs off the bed, keeping them straight.
Take your time over this examination, and repeat it to see if you get consistent results.
If taking the pressure off your innards by lifting your legs, reduces the tenderness, then some organ in your abdomen is tender.
If the tenderness remains the same or increases, it is tenderness of the muscles of your abdominal wall. This is seldom due to anything wrong with the muscles, but usually because of one of your spine joints is stuck and sore.
Pain has spread (been "referred") from the back, and as always, tenderness accompanies the referred pain.The nerves to your abdominal wall skin, come from spinal segments T6 to T12 in the upper back. Examination of this area is detailed on the thoracic spine page of this site.
This test is useful for checking any abdominal tenderness. If multiple areas of your tummy are tender, you can do this test on each of them.
If I find this indicates a back problem, I will treat the back and then come back and re-examine the persons tummy. It is not unusual to initially find tenderness unchanged by lifting the legs, and then on the re-check to find the reverse.
This indicates both a back problem plus an abdominal organ problem.
Carnett's sign is a variation on this test. The first description
of my test was many years ago in a paper on intercostal neuralgia v.
abdominal pain diagnosis.
Very localized abdominal wall tenderness plus a lump to feel here, may be due to a complicated hernia here. Abdominal pain diagnosis includes looking for lumps in your abdominal wall. Use a circular motion with the pads of your middle 3 fingers.
Epigastric hernias may be fatty hernias of the linea alba. These are little bits of fat poking out between the 6 packs in the mid line of the upper abdomen.
These are often irreducible, there all the time. They may come and go, and be tender only when poking out.
Spigellian hernias are along the outer edge of the 6 pack. These come and go, and contain bowel. Bowel can become stuck in a hernia and swell up, obstructing the bowel. This causes severe colicy central abdominal pain as well as the sore hernia.Umbilical
hernias poke out through our tummy button, or just above or below it.
It's not just for abdominal pain diagnosis, but also a treatment.
If you have griping abdominal pain especially, it's worth giving your tummy a few sharp flicks with your finger.
This is a technique used by surgeons to produce visible peristalsis, if they suspect a bowel obstruction. It makes the bowel contract, and if the person is thin enough, the wave of contraction can be seen through their abdominal wall.
If this relieves your pain, the pain was coming from your intestines - something to tell your doctor.