abdomen

• The Abdomen


  The abdomen is the area of the body between the chest and the pelvis
• The Four Quadrants of Abdomen

  • The abdomen is divided into four quadrants: upper right, upper left, lower right, lower left
• The Nine Abdominal Regions

  • The abdomen is divided into nine regions: right upper, right middle, right lower, left upper, left middle, left lower, epigastric, umbilical, hypogastric
• GASTROINTESTINAL DISORDERS


  • Abdominal pain, acute and chronic
  • Indigestion, nausea, vomiting including blood, loss of appetite, early satiety
  • Dysphagia and/or odynophagia
  • Change in bowel function
  • Diarrhea, constipation
  • Jaundice
• URINARY and RENAL DISORDERS

  • Suprapubic pain
  • Dysuria, urgency, or frequency
  • Hesitancy, decreased stream in males
  • Polyuria or nocturia
  • Urinary incontinence
  • Hematuria
  • Kidney or flank pain
  • Ureteral colic
• Visceral pain


  Occurs when hollow abdominal organs such as the intestine or biliary tree contract unusually forcefully or are distended or stretched. Varies in quality and may be gnawing, burning, cramping, or aching. When it becomes severe, it may be associated with sweating, pallor, nausea, vomiting, and restlessness.
• Parietal pain


  Originates from inflammation in the parietal peritoneum. Is a steady, aching pain that is usually more severe than visceral pain and more precisely localized over the involved structure. Is typically aggravated by movement or coughing. Patients with this type of pain usually prefer to lie still.
• Referred pain


  Is felt in more distant sites, which are innervated at approximately the same spinal levels as the disordered structures. Often develops as the initial pain becomes more intense and thus seems to radiate or travel from the initial site. May be felt superficially or deeply but is usually well localized.
• Acute Upper Abdominal Pain, Discomfort


  Timing of the pain (acute or chronic), describe the pain in their own words, point to the pain, severity of the pain, factors that aggravate or relieve the pain
• Chronic Upper Abdominal Discomfort or Pain

  DYSPEPSIA is defined as chronic or recurrent discomfort or pain centered in the upper abdomen. DISCOMFORT is defined as a subjective negative feeling that is nonpainful. It can include various symptoms such as bloating, nausea, upper abdominal fullness, and heartburn.
• Heartburn


  Is a rising retrosternal burning pain or discomfort occurring weekly or more often. Is typically aggravated by food such as alcohol, chocolate, citrus fruits, coffee, onions, and peppermint; or positions like bending over, exercising, lifting, or lying supine.
• Acute Lower Abdominal Pain


  Acute pain localized to the RLQ (find out if it is sharp and continuous or intermittent and cramping, causing them to double over), Acute pain in the LLQ or diffuse abdominal pain (investigate associated symptoms such as fever and loss of appetite)
• Chronic Lower Abdominal Pain


  Ask about change in bowel habits and alternating diarrhea and constipation
• Nausea


  Often described as "feeling sick to my stomach," may progress to retching and vomiting.
• Retching


  Describes involuntary spasm of the stomach, diaphragm, and esophagus that precedes and culminates in vomiting, the forceful expulsion of gastric contents out of the mouth.
• Regurgitation


  Some patients may not actually vomit but raise esophageal or gastric contents without nausea or retching.
• Anorexia


  Loss or lack of appetite. Find out if it arises from intolerance to certain foods or reluctance to eat because of anticipated discomfort. Check for associated symptoms of nausea and vomiting.
• Unpleasant Abdominal Fullness


  After light or moderate meals, or early satiety, the inability to eat a full meal.
• Other Gastrointestinal Symptoms


  • Dysphagia
  • Odynophagia
  • Change in bowel function
  • Diarrhea and Constipation
  • Jaundice
• THE URINARY TRACT


  • Suprapubic pain
  • Dysuria, Urgency, or Frequency
  • Polyuria
  • Nocturia
  • Urinary Incontinence
  • Hematuria
  • Kidney Pain
  • Ureteral Pain
• Dysuria


  Painful urination
• Urgency


  An unusually intense and immediate desire to void, sometimes leading to involuntary voiding or urge incontinence
• Frequency


  Abnormally frequent voiding
• Urinary Incontinence


  An involuntary loss of urine that may become socially embarrassing or cause problems with hygiene.
• Kidney Pain


  Often reported as flank pain at or below the posterior costal margin near the costovertebral angle.
• Ureteral Pain


  It is usually severe and colicky, originating at the costovertebral angle and radiating around the trunk into the lower quadrant of the abdomen, or possibly into the upper thigh and testicle or labium.
• TECHNIQUES OF EXAMINATION


  • Good light, Relaxed and well-draped patient, with exposure of the abdomen from just above the xiphoid process to the symphysis pubis, The groin should be visible, The genitalia should remain draped, The abdominal muscles should be relaxed to enhance all aspects of the examination, especially palpation.
• Tips for Enhancing Examination of the Abdomen

  • Check that the patient has an empty bladder, Make the patient comfortable in the supine position, Ask the patient to keep the arms at the sides or folded across the chest, Before you begin palpation, ask the patient to point to any areas of pain so you can examine these areas last, Warm your hands and stethoscope, Approach the patient calmly and avoid quick, unexpected movements, Distract the patient if necessary with conversation or questions.
• INSPECTION


  • Skin, Umbilicus, Contour of the abdomen, Peristalsis, Pulsations
• Skin


  • Note scars, striae, dilated veins, rashes and lesions
• Contour of the Abdomen

  Is it flat, rounded, protuberant, or scaphoid (markedly concave or hollowed)?
• Umbilicus


  Observe its contour and location and any inflammation or bulges suggesting a hernia
• Contour of the Abdomen


  Do the flanks bulge, or are there any local bulges? Also survey the inguinal and femoral areas.
• Skin


  • Scars - Describe or diagram their location
  • Striae - Old silver striae or stretch marks are normal
  • Dilated veins - A few small veins may be visible normally
  • Rashes and lesions
• Abnormalities


  • Pink-purple striae of Cushing's syndrome
  • Dilated veins of hepatic cirrhosis or of inferior vena cava obstruction
• Contour of the abdomen

  Flat, rounded, protuberant, or scaphoid (markedly concave or hollowed)
• Contour of the abdomen

  • Bulging flanks of ascites; suprapubic bulge of a distended bladder or pregnant uterus; hernias
  • Asymmetry from an enlarged organ or mass
• Contour of the abdomen

  • Lower abdominal mass of an ovarian or a uterine tumor
• Peristalsis


  • Increased peristaltic waves of intestinal obstruction
• Pulsations


  • Increased pulsation of an aortic aneurysm or of increased pulse pressure