Is there a preferred order to palpate the abdomen? Should you start in one quatdrant first and end in another?

Question

Patient assessment in a prehospital setting. Was told once that itwas safer to start in a counterclockwise position starting from RUQ ending at LUQ. This is of course for an unconscious unknown patient.

Answer 1

I've never been told that there was a specific sequence to doing an abdominal exam. It's always a good idea to start at the upper quadrants and then palpate the lower quadrants. Save the abdominal palpation for last (do inspection, ascultation, and percussion first) because palpation is the more painful exam. If you always perform your exam in the same order, it reduces the chances that you will miss something. I just finished rereading my textbook on abdominal exam and it does not mention anything about it being "safer" to do the exam in a counterclockwise fashion. Of course in a conscious patient, it's a good idea to ask the patient what part of the abdomen is painful and then palpate that quadrant last.