About 2 to 3 times each year I get asked to see a patient with chronic, unresolving, and undiagnosed abdominal pain. Invariably, these patients have seen several gastroenterolo-gists before me, have had as many CT scans in addition to the requisite EGD and colonoscopy that attends almost all gas-troenterology visits today, and have been unsuccessfully treated with proton pump inhibitors and a variety of pain medications, sometimes including narcotics. The one thing these patients may not have had is a thoughtful and compulsive abdominal examination. In fact, as I was examining the abdomen of the last such patient I saw with these complaints, he looked up at me and said, "you know, Dr. Brandt, you are the first doctor who has touched me." In addition to being embarrassed for our profession, I thought, as the kids of today say, "Oh, my God." That patient's comments prompted me to write this page on how to touch an abdomen. Of course, touch is preceded by inspection and after the patient has unclothed, inspection is performed for scars (trauma, surgery-either laparotomy or laparoscopy), hyper- or hypo-pigmentation (radiation, melanoma, Addison's disease, Kohlmeir-Degos disease), and asymmetry (hernias, organo-megaly, masses). After touch, the examiner arrives upon the subject of this page: Gentle Stroking and Delicate Pinching.
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