HAS FINALS - 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
• Methods of dividing the abdominal cavity

  • By quadrants
  • By regions
• Stomach


  1. shaped pouch like organ 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, breakdown 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, Segments: duodenum, jejunum, ileum
• Large intestine


  Tubular shaped organ extending from the ileocecal valve to the anus, greater diameter than the small intestine, Segments: ascending, transverse, descending
• Sigmoid colon


  Functions: 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, Functions: storage, detoxification and filtration, metabolism, synthesis and secretion
• Gallbladder


  Pear-shaped sac located in the right upper quadrant of the abdomen, Functions: store and concentrate bile produced by the liver, contributes 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, Functions: 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, Functions: serves 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, Functions: 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
• Order of Assessment for the Abdomen

  1. Inspection

  2. Auscultation

  3. Percussion

  4. Palpation
• Abdominal contour


  • Normal: flat, rounded, evenly rounded
  • Deviations: generalized protuberant or distended abdomen, distended below umbilicus, distended upper abdomen
• Abdominal symmetry


  • Normal: symmetrical bilaterally
  • Deviations: asymmetry may be seen with organ enlargement, large masses, hernia, diastasis recti, or bowel obstruction
• Abdominal pigmentation and color

  • Normal: paler than general skin tone
  • Deviations: purple discoloration at the flanks (Grey - Turner sign), bruises or areas of discoloration, redness, pale taut skin
• Abdominal scars


  • Normal: pale, smooth, minimally raised old scars
  • Deviations: nonhealing wounds, redness, inflammation, deep irregular scars
• Abdominal pulsation


  • Normal: ripples of peristalsis, peristalsis movement slowly traverses the abdomen in a slanting downward direction
• Abdominal striae (stretch marks)

  • Normal: pink, bluish in color if new, silvery, white, linear if old, uneven from past pregnancies or weight gain
  • Deviations: dark bluish - pink striae associated with Cushing syndrome, stretch marks caused by ascites
• Abdominal masses/nodules


  • Normal: no masses or nodules present in the umbilicus, depressed and beneath the abdominal surface, protruding not more than 0.5cm, round or conical, skin tones similar to surrounding, midline
  • Deviations: Cullen sign - indicates intra-abdominal bleeding, deviated umbilicus, everted umbilicus
• Bowel sounds


  • Normal: always present at the ileocecal valve area (RLQ), hyperactive bowel sounds referred to as "borborygmus", loud, prolonged gurgles
  • Deviations: hyperactive - gastroenteritis, diarrhea, use of laxatives, hypoactive - paralytic ileus, peritonitis, bowel obstruction
• Vascular sounds (bruits)


  Low-pitched, murmur-like sound, use bell of stethoscope
• Cullen sign


  Indicates intra-abdominal bleeding
• Bowel sounds


  Heard as intermittent gurgling sounds throughout the abdominal quadrants at a rate of 5 – 30 per minute
• Normal bowel sounds


  • Always present at the ileocecal valve area (RLQ)
  • Hyperactive bowel sounds referred to as "borborygmus"
  • Loud, prolonged gurgles characteristic of one's stomach growling
• Hyperactive bowel sounds


  • Caused by gastroenteritis, diarrhea, or use of laxatives
• Hypoactive bowel sounds


  • Caused by paralytic ileus, peritonitis, or bowel obstruction
• Bruits


  Low-pitched, murmur-like sound, whooshing sound of blood flowing through a narrow vessel, auscultated over the abdominal aorta and renal, iliac, and femoral arteries
• Bruits


  • Not normally heard, may indicate aneurysm and/or renal arterial stenosis
• Venous hum


  Sounds produced by abdominal organs that suggests increased collateral circulation, heard over the umbilicus and epigastric area
• Friction rub


  High-pitched grating sound produced by large surface of an abdominal organ (liver, spleen) rubbing the peritoneum
• Friction rub


  • Associated with respiration, rare and not normally heard
• Tympany


  Predominant sound heard because air is present in the stomach and in the intestines
• Dullness


  Normally heard over organs such as the liver or a distended bladder
• Liver span assessment


  1. Begin liver percussion in the RLQ and percuss upward toward the chest

  2. Percuss over the upper right chest at the MCL and percuss downward

  3. Measure the distance between the two marks: this is the span of the liver