Abdomen

• Intraperitoneal organs


  Organs covered with peritoneum and held in place by mesentery

  
• Intraperitoneal organs


  • Spleen
  • Bile duct
  • Gallbladder
  • Small intestine
  • Stomach
  • Large intestine
  • Liver
• Retroperitoneal organs


  Organs situated behind the peritoneum and without mesenteric attachment
• Retroperitoneal organs


  • Pancreas
  • Ureters
  • Kidneys
  • Bladder
• Anatomical mapping by quadrants


  • Most common assessment approach
  • A vertical line from the xiphoid process to the pubic symphysis and a horizontal line across the umbilicus
  • The location of organs by quadrants

  
• Anatomical mapping by regions

  The vertical lines that extend superiorly from the midpoints of the inguinal ligaments and 2 horizontal lines, one at the level of the edge of the lower ribs and the other at the level of the iliac crest

  
• Stomach


  • J-shaped pouch like organ located in the left upper quadrant of the abdomen beneath the diaphragm
  • Lies to the right of the spleen and is partially covered by the liver
  • Reservoir where the complex mechanical and chemical processes of digestion occurs
  • Breaks down food particles into the molecular form of digestion

  
• Small intestine


  • Tubular-shaped organ extending from the pyloric sphincter to the ileocecal valve at the opening of the large intestine
  • Can measure from 10 feet to 30 feet
  • Duodenum: 1st and shortest section, significant role in digestion
  • Jejunum: Composed of circular mucosal folds that provide surface area for nutrient absorption
  • Ileum: Absorbs bile salts and Vitamin B12
• Large intestine


  • Tubular shaped organ extending from the ileocecal valve to the anus
  • Greater diameter than the small intestine
  • Ascending
  • Transverse
  • Descending
  • Sigmoid colon
• Functions of large intestine

  • Form stool from cellulose, indigestible fibers, fat, bacteria, cellular debris and inorganic materials
  • Carry these intestinal contents to the end of the GIT
  • Absorption of water and electrolytes
• Liver


  • Largest solid organ in the body lies directly below the diaphragm
  • Located in the right upper quadrant but extends across the midline into the left upper quadrant
  • Storage: Carbohydrates, amino acids, vitamins, minerals, blood
  • Detoxification and filtration: Drugs, hormones, bacteria
  • Metabolism: Carbohydrates, proteins, fats, ammonia to urea
  • Synthesis and secretion: Bile production, formation of lymph, bile salts, plasma proteins, fibrinogen, blood-clotting substances, antibodies

  
• Gallbladder


  • Pear-shaped sac located in the right upper quadrant of the abdomen
  • Store and concentrate bile produced by the liver
  • Contribute to fat digestion and absorption
  • Stores approximately 30 to 50 ml of bile
• Pancreas


  • Elongated accessory organ of digestion lies in a transverse position along the posterior abdominal wall
  • Exocrine: Secretes bicarbonate and pancreatic enzymes which aid in digestion
  • Endocrine: Secretes the hormone insulin, glucagon and gastrin

  
• Spleen


  • Largest lymph of the body oval in shape found at the upper left quadrant of the abdomen
  • Serves the body as filter and reservoir for red blood cell mass
• Vermiform appendix


  Finger-like shape that extends off the lower cecum in the right lower quadrant
• Kidneys


  • Bean-shaped organs that lie tucked against the posterior abdominal wall
  • Get rid of the body waste products
  • Acid base balance, fluid and electrolyte balance, arterial blood pressure
• Ureters


  The passageway of urine from the kidneys
• Bladder


  Stores urine can hold 200 to 400 ml of urine
• Equipment for abdominal assessment

  • Drapes
  • Tape measure or small ruler with centimeter markings
  • Marking pen
  • Stethoscope
• Order of abdominal assessment

  • Inspection
  • Auscultation
  • Percussion
  • Palpation
• General approach to abdominal assessment

  1. Greet the patient and explain the assessment technique

  2. Ensure that the room is at a warm, comfortable temperature to prevent patient chilling and shivering

  3. Use a quiet room that will be free from interruptions

  4. Utilize an adequate light source

  5. Ask the patient to urinate before the exam

  6. Drape the patient from the xiphoid process to the symphisis pubis then expose the patient's abdomen

  7. Position the patient comfortably in a supine position with knees flexed over a pillow or position the patient so that the arms are either folded across the chest or at the sides to ensure abdominal relaxation

  8. Stand to the right side of the patient for the examination

  9. Visualize the underlying abdominal structures during the assessment process in order to accurately describe the location of any pathology

  10. Have the patient point to tender areas; assess these last. Mark these and other significant findings on the body diagram in the patient's chart

  11. Watch the patient's face closely for signs of discomfort or pain

  12. Help the patient relax by using unhurried approach, diverting attention with questions and so on

  13. Ensure that your hands and the stethoscope are warm to promote patient comfort
• Normal abdominal contour


  • Flat (straight horizontal line from costal margin to symphysis pubis)
  • Rounded (convexity of the abdomen from costal margin to symphysis pubis)
  • Abdomen should be evenly rounded
• Deviations from normal abdominal contour


  • Generalized protuberant or distended abdomen may be due to obesity, air or fluid accumulation
  • Distended below umbilicus may be due to a full bladder, uterine enlargement, or an ovarian tumor or cyst
  • Distended upper abdomen may be due to masses of pancreas or gastric dilation
• Normal abdominal symmetry


  Abdomen should be symmetrical bilaterally
• Deviations from normal abdominal symmetry

  Asymmetry may be seen with organ enlargement, large masses, hernia, diastasis recti, or bowel obstruction
• Normal abdominal pigmentation and color

  Abdominal skin may be paler than the general skin tone because it is seldom exposed to the natural elements
• Deviations from normal abdominal pigmentation and color

  • Purple discoloration at the flanks (Grey – Turner sign) indicates bleeding within the abdominal wall, possibly from trauma of abdominal organs (pancreas, kidneys, intestines, or from pancreatitis
  • Pale, taut skin may be seen with ascites
  • Redness may indicate inflammation
  • Bruises or areas of discoloration
• Normal abdominal scars


  Pale, smooth, minimally raised old scars may be seen
• Deviations from normal abdominal scars

  • Nonhealing wounds, redness, inflammation
  • Deep irregular scars may result from burns
• Normal abdominal striae


  • Pink, bluish in color if new striae
  • Silvery, white, linear if old striae
  • Uneven stretch marks from past pregnancies or weight gain
• Deviations from normal abdominal striae

  • Dark bluish – pink striae are associated with Cushing syndrome
  • Stretch marks caused by ascites
• Normal abdominal masses/nodules


  No masses or nodules
• Grey – Turner sign


  Purple discoloration at the flanks indicating bleeding within the abdominal wall, possibly from trauma of abdominal organs (pancreas, kidneys, intestines) or from pancreatitis
• Pale, taut skin


  • May be seen with ascites
• Redness


  • May indicate inflammation
• Scar


  • Normal: Pale, smooth, minimally raised old scars
  • Deviations from normal: Nonhealing wounds, redness, inflammation
  • Deep irregular scars may result from burns
• Striae


  • Stretch Marks: Normal - Pink, bluish if new, Silvery, white if old, Uneven from past pregnancies or weight gain
  • Deviations from normal - Dark bluish-pink striae associated with Cushing syndrome, Stretch marks caused by ascites
• Masses / Nodules


  • Normal: No masses or nodules present
• Umbilicus


  • Normal: Depressed and beneath the abdominal surface, protruding not more than 0.5cm, Round or conical, Skin tones similar to surrounding, Midline
  • Deviations from normal: Cullen sign (indicates intra-abdominal bleeding), Deviated umbilicus, Everted umbilicus
• Peristalsis


  • Normal: Ripples may be observed in thin patients, Slowly traverses the abdomen in a slanting downward direction