Physical exam includes rectal palpation of an L shaped rumen with the ventral rumen sac to the right of the midline. The left paralumbarfossa and right ventral abdominal quadrant will be distended, resulting in the characteristic "papple" shaped abdominal contour. (The left side looks "apple" shaped and the right side looks "pear" shaped.) Palpation of the pharynx and esophagus can help to locate inflammation, cellulitis or a foreign body. Hydration status can be assessed by tenting the skin above the eye and observation of the eye's location in the orbit. Passage of a Kinginan tube will determine if rumen distention is due to free gas or ingesta.