This is abnormal separation of the abdominal rectus muscles. The latter indicates obstruction of a tubular viscus. Visibility may be caused by normal waves showing through a thin abdominal wall or by abnormally powerful waves beneath a normal wall. Occasionally, parallel ridges form a “ladder” pattern. They usually appear as oblique ridges in the wall that begin near the left upper quadrant and gradually move downward and rightward. Peristaltic waves in the stomach or small bowel sometimes can be seen in the upper abdomen. In fact, more than one third of intestinal obstructions do not even have abdominal distention.įigure 15-5 A, Visible peristalsis. Unfortunately, visible peristalsis is only present in 6% of patients, and decreased or absent bowel sounds are present in one quarter of cases. Visible peristaltic waves also can occur in intestinal obstruction, and when associated with abdominal distention and hyperactive bowel sounds, they argue favorably for the presence of the condition. 15-3).Ī “ladder” pattern of abdominal distention is typical of small bowel obstruction ( large bowel obstruction produces instead an inverted-U pattern) ( see Fig. 15-2).Ī bulge over the two upper quadrants is seen in hepatosplenomegaly (Fig.
This lopsided protuberance should not be confused with a fat belly, which on lateral view appears instead as a convex arching of the abdominal contour, peaking at the umbilicus.Ī localized bulge over the hypogastric area is typical of a distended urinary bladder ( see Fig.
15-2).Ī discrete bulge in the epigastric area is seen in large pericardial effusions ( Auenbrugger’s sign, from the name of the inventor of percussion). A Cupid’s bow profile is typical of acute pancreatitis, with the midpoint between the two bow branches coinciding with the umbilical retraction from localized peritonitis (Fig.
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