Abdomen

• Anatomic Divisions


  • Abdominal quadrants
  • Abdominal wall muscles
  • Intestinal anatomy of the abdominal cavity
• Abdominal Quadrants


  • Right Upper Quadrant
  • Right Lower Quadrant
  • Left Lower Quadrant
  • Left Upper Quadrant
• Abdominal quadrants


  • Midline - tip of the sternum-umbilicus-symphysis pubis
  • Lateral - runs through the umbilicus across the abdomen
• Contents of Abdominal Quadrants

  • RUQ - liver, gallbladder, duodenum (small intestine), pancreas head, right kidney and adrenal
  • LUQ - stomach, spleen, pancreas, left kidney and adrenal
  • RLQ - cecum, appendix, right ovary and tube
  • LLQ - sigmoid colon, left ovary and tube
• Abdominal Wall Muscles


  • External abdominal oblique - outermost
  • Internal abdominal oblique - middle
  • Transverse abdominis - innermost
• Parietal Peritoneum


  A thin shiny serous membrane that lines the abdominal cavity
• Visceral Peritoneum


  Provides a protective covering for most of the abdominal organs
• Abdominal Organs


  • Solid viscera - kidneys, pancreas, ovaries and uterus, liver and adrenal glands
  • Hollow viscera - stomach, gallbladder, small intestine, colon and bladder
• Infants


  • Bladder is located above the symphysis pubis
  • Liver proportionately takes up more space in the abdomen and may extend 2 cm (3⁄4 inch) below the rib cage
  • Abdominal muscles are weak, so the abdomen normally protrudes
• Children


  • Abdomen is proportionately larger than an adult's and has a slightly protuberant appearance because of the curvature of the back
  • Abdominal muscles are underdeveloped, so organs are more easily palpated
• Pregnant Women


  • Abdominal muscles relax, allowing the uterus to protrude
  • For multiple pregnancies, the rectis abdominis muscles become separated (diastasis recti abdominis)
  • As the fetus grows, it takes up more room in the uterus, causing the stomach to rise up and impinge on the diaphragm
  • Bowel sounds are diminished, decreased activity in the lower GI tract
  • Prenatal vitamins cause constipation
  • Increased venous pressure in the lower abdomen causes hemorrhoids to develop
  • Linea nigra, a darkly pigmented line, appears on the anterior abdomen
  • Striae (stretch marks) develop from the increased tension of the expanding uterus
• Older Adults


  • Body systems slow down and become less efficient
  • Changes in dentition affect chewing ability and digestion
  • Poorly fitted dentures may result in painful mastication, causing the patient to select foods that are easier to chew but not necessarily nutritionally balanced
  • In the GI tract, there is a reduction of saliva, stomach acid, gastric motility, and peristalsis that causes problems with swallowing, absorption, and digestion
  • Reduction of muscle mass and tone contributes to constipation
  • Fat accumulates in the lower abdomen in women and around the waist in men, making physical assessment of the organs more challenging
  • The liver becomes smaller and liver function declines, making it harder to process medications
• Collecting Subjective Data


  • History of present health concern
  • Past health history
  • Family history
  • Lifestyle and health history
• History of Present Health Concern

  • Abdominal pain
  • Indigestion
  • Nausea and Vomiting
  • Appetite
  • Bowel Elimination
• Factors Contributing to Abdominal Pain

  • Chemical
  • Mechanical
  • Inflammation
  • Distention
  • Pressure
  • Trauma
  • Infection
  • Stretching
• COLDSPA


  • C - How does it feel, look, sound or smell?
  • O - When did it begin?
  • L - Where is it? Does it radiate?
  • D - How long does it last? Does it recur?
  • S - How bad it is?
  • P - What makes it better? What makes it worse?
  • A - What other symptoms occur with it?
• Visceral Pain


  Results from distension of the intestines or stretching of the solid organs. It is often described as burning, cramping, diffuse, and poorly localized.
• Parietal Pain


  Results from inflammation of the parietal peritoneum. The pain is usually severe, localized, and aggravated by movement.
• Referred Pain


  Is felt at a site away from the site of origin. Impulses from the internal organs and structures that share nerve pathways inside the central nervous system explain the nature of referred pain.
• Purposes of Abdominal Examination

  • To explore gastrointestinal complaint
  • To assess abdominal pain, tenderness or masses
  • To monitor the client post-operatively
• Assessment Procedures


  • Inspection
  • Auscultation
  • Percussion
  • Palpation
• Auscultate after you inspect as not to alter the client's pattern of bowel sounds.
• Before touching the abdomen, ask the client about painful or tender areas. These areas should always be assessed at the end of the examination.
• Preparing the Client


  • Perform the examination in a warm, private environment
  • Adequate lighting for better visualization
  • Draping to remove clothes and put on gown
  • Equipment - flat pillow, rolled blanket, centimeter ruler, stethoscope, marking pen
  • Ask the client to empty the bladder
  • Position the client supine with arms folded or resting by the sides
  • Instruct the client to breathe through the mouth and take slow, deep breaths
• Inspection


  • Skin - color, vascularity, striae, scars, lesions and rashes
  • Umbilicus - color, location, contour, discharges
  • Symmetry/abdominal girth/considerations
  • Movement - aortic pulsation, peristaltic waves
• Auscultation


  • Bowel sounds
  • Friction rub
  • Vascular sounds
• Percussion


  • Tone
  • Span or height
• Palpation


  • Masses/bulges
  • Swelling
• Inspect the abdominal contour by looking across the abdomen at eye level from the client's side, from behind the client's head, and from the foot of the bed.
• Assess abdominal symmetry as the client lies in a relaxed supine position.
• Begin auscultation of bowel sounds in the RLQ and proceed clockwise.
• For vascular sounds, use the bell of the stethoscope over the abdominal aorta, renal iliac and femoral arteries.
• Percuss the spleen, beginning posterior to the left mid-axillary line and percussing downward.
• Percuss the liver, beginning in the RLQ and percussing upward toward the chest.
• Perform light palpation to identify areas of tenderness and muscular resistance, compressing to a depth of 1 cm.
• Perform deep palpation to delineate abdominal organs and detect subtle masses, compressing to a maximum depth of 5-6 cm.
• Palpate the aorta using your thumb and first fingers or two hands, in the epigastrium slightly to the left of midline.
• Palpate the liver by standing at the client's right side, placing your left hand under the client's back at the level of the 11th-12th ribs.
• Palpate the kidneys by supporting the right posterior flank with your left hand and palpating the RUQ just below the costal margin at the MCL.
• Palpate the urinary bladder by beginning at the symphysis pubis and moving upward and outward to estimate the bladder borders.