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Abdomen

Abdomen

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Structure and Function

Surface landmarks

Xiphoid process

Umbillicus (may be unreliable)

ASIS

Internal anatomy

(viscera)

Solid viscera Liver Pancreas Spleen Adrenal glands Kidneys Ovaries Uterus

Hollow viscera Stomach Gallbladder Small intestine Colon Bladder

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V i   s  c  er  al   A n

 at  om y

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Subjective Data—Health History Questions

Infectious Disease- Hepatitis, HIV/AIDS, C-diff, influenza, e-coli

Appetite/weight changes

Dysphagia- timing, diet

Food intolerance- high fibre foods, gas-producing foods,lactose intolerance, allergies

Abdominal pain- PQRSTU critical! Characteristics often identifythe cause

Nausea/vomiting- pregnancy, associated infection symptoms,medications/food taken, timing

Bowel habits- regularity, consistency, colour, odour,constipation/diarrhea, pain, bloating

Medications- dyspepsics, opioids/iron, sedatives/anesthetics,NSAIDS/ASA, antibiotics

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Objective Data— The Physical Exam, cont.

Inspect the Abdomen

Contour →

Umbilicus= midline, no herniation

Skin= uniform

Pulsations- AA in thin persons

Hair distribution- appropriate to developmental stage and gender 

Demeanor- no guarding

Presence of striae- common post-pregnancy, puberty growth spurts, weight gain/loss

Movement with respirations

Visible peristalsis- ineffective

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Objective Data— The Physical Exam, cont.

 Auscultate the Abdomen

Bowel sounds- start RLQ listen for 5 full minutes in each

quadrant before determining

absence “silent abdomen” is emergent

Effective= “normoactive”

Vascular sounds Bruits= ineffective turbulent blood

flow

Percuss the Abdomen

General tympany overintestines

Splenic dullness (norm 6-8cmabove L costal margin)

Costovertebral angletenderness

kidney inflammation

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Objective Data— The Physical Exam, cont.

Normally palpable structures:

Abdominal aorta Palpate very lightly 

Right kidney May be palpable

Lower due to liver’s size

Liver Hooking technique

Scratch technique

Abnormally palpableorgans:

Spleen

Can enlarge significantly “splenomegaly” 

Left Kidney

Bladder

Palpable only when distended 

Special procedures

A. Rebound tenderness

- indicates appendicitis

B. Fluid wave

- indicates ascites

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Objective Data— The Physical Exam, cont

Palpate the Liver

Manual vs. bi-manual

technique Measures to enhance

muscle relaxation

Effective adult size= 6-

12cm size often increased in

taller persons and men

Hooking Technique

Scratch Technique

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Abnormal FindingsAbdominal Distention

FAT

FLATUS

FLUID

FIBROIDS

FETUS

FECES

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Abnormal FindingsAbnormal Bowel Sounds

Hypoactive bowel sounds = decreasedmotility

Hyperactive bowel sounds= increased motility