Transcript Abdomen

The Abdomen
Lecture 6
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Anatomy of the Abdomen
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Anatomy of the Abdomen
(Abdominal Cavity)
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Four Quadrants
• Midsternal line from the xiphoid process through the umbilicus to the
pubic bone
• Horizontal line perpendicular to the first line through the umbilicus
• Quadrants named
– Right upper quadrant (RUQ)
– Right lower quadrant (RLQ)
– Left upper quadrant (LUQ)
– Left lower quadrant (LLQ)
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Nine Regions
• Extend the right and left midclavicular lines to the groin
• Horizontal line across the lowest edge of the costal
margin
• Horizontal line at the level of the iliac crests
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Anatomy of the Abdomen (cont.)
Dividing the Abdomen
into Four Quadrants
Dividing the Abdomen
into Nine Sections
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History Taking of Problems of the
Abdomen: GI Tract
• How is the patient’s appetite?
-Anorexia: lack of an appetite
• Weight Loss
• Any symptoms of the following?
– Heartburn: a burning sensation in the epigastric
area radiating into the throat; often associated
with regurgitation
– Excessive gas or flatus
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History Taking of Problems of the
Abdomen: GI Tract (cont.)
• Regurgitation: the reflux of food and stomach acid
back into the mouth.
• Vomiting; retching (spasmodic movement of the
chest and diaphragm like vomiting, but no stomach
contents are passed)
– Ask about the amount of vomit
– Ask about the type of vomit
– Hematemesis: is blood or coffee ground emesis
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History Taking of Problems of the
Abdomen: GI Tract (cont.)
• Ask patients to describe the abdominal pain in their own words
• Ask patients to point with one finger to the area of pain
• Ask about the severity of pain (scale of 1 to 10)
• Ask what brings on the pain (timing)
• Ask patients how often they have the pain (frequency)
• Ask patients how long the pain lasts (duration)
• Ask if the pain goes anywhere else (radiation)
• Ask if anything aggravates the pain or relieves the pain
• Ask about any symptoms associated with the pain
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History Taking of Problems of the
Abdomen: GI Tract (cont.)
• Ask about prior medical problems related to the abdomen
– Hepatitis, gallbladder problems, or pancreatitis, for
example
• Ask about prior surgeries of the abdomen
• Ask about use of tobacco, alcohol, illegal drugs, as well
as medication history
• Ask about hereditary disorders affecting the abdomen
in the history of the patient’s family
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Medical problems related to the abdomen
• Hepatitis: is a medical condition defined by the
inflammation of the liver and characterized by the
presence of inflammatory cells in the tissue of the organ.
• Pancreatitis is the inflammation of the pancreas.
Pancreatitis may be acute or chronic.
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History Taking of Problems of the
Abdomen: GI Tract (cont.)
• Ask the patient about bowel movements
– Frequency of the bowel movements
– Consistency of the bowel movements
(diarrhea vs. constipation)
– Any pain with bowel movements
– Ask about the color of the stools (white or gray stools
can indicate liver or gallbladder disease)
– Ask about difficulty
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History Taking of Problems of the
Abdomen: Urinary Tract
• Ask about frequency (how often one urinates) and urgency
(feeling like one needs to urinate but very little urine is
passed)
• Ask about any pain with urination
• Ask about the color and smell of the urine; red urine usually
means hematuria (blood in the urine)
• Ask about difficulty starting to urinate
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Physical Examination of the Abdomen:
Inspection
• Inspect the abdomen
– Look at the skin: scars, striae (stretch marks), rashes, or lesions
(Stretch marks or striae (singular stria), as they are called in
dermatology, are a form of scarring on the skin with an off-color hue.
They are caused by tearing of the dermis, and over time can diminish
but not disappear completely)
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Physical Examination of the Abdomen:
Inspection
– Look at the umbilicus: observe contour and location and any signs
of an umbilical hernia
(An umbilical hernia occurs when part of the intestine protrudes
through an opening in the abdominal muscles. Umbilical hernias are
most common in infants, but they can affect adults as well)
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Physical Examination of the Abdomen:
Inspection
– Look at the contour of the abdomen: flat, rounded, protuberant, or
scaphoid
– Is the abdomen symmetric?
– Inspect for signs of peristalsis (rhythmic movement of the intestine
that can be seen in thin people) and pulsations (within blood vessels
such as the aorta)
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Physical Examination of the Abdomen:
Auscultation
• Auscultation is done before percussion and palpation since
those maneuvers could potentially change the frequency and
character of bowel tones.
• Place the diaphragm over the abdomen to hear bowel sounds.
These sounds are transmitted across the abdomen so it is not
necessary to listen at multiple places. The normal frequency
of sound is 5-34 sounds per minute.
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Physical Examination of the Abdomen:
Auscultation
• Listen for bruits over the renal arteries, iliac arteries, and aorta by using the
diaphragm of stethoscope
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Physical Examination of the Abdomen:
Percussion
• Percuss over all four quadrants, listening for tympany (hollow
sounds over the gastric bubble). Dullness is heard over the liver
and spleen or a mass.
• Percuss over the liver in both the right midclavicular line
and at the right midsternal line
– Midclavicular percussion should be 5–10 cm; longer than
this indicates an enlarged liver
– Midsternal line percussion should be 4–9 cm; shorter than
this can indicate a small, hard liver
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Abdomen Percussion
Percussion pattern for liver
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Physical Examination of the Abdomen:
Light and Deep Palpation
• Start palpating the abdomen using gentle probing with
the hands; this reassures and relaxes the patient
• Do not drag your hand over the surface of the skin
• Identify any superficial organs or masses or tenderness
• Use relaxation techniques to assess voluntary guarding
– Tell the patient to breathe out deeply
– Tell the patient to breathe through the mouth
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Light palpation of abdomen
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Physical Examination of the Abdomen:
Deep Palpation
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Physical Examination of the Abdomen: Deep Palpation-Palpating
the liver-(Standard technique)
• Use your left hand to lift the lower rib cage and flank.
• Press down just below the right costal margin with your right hand.
• Ask the patient to take a deep breath.
• You may feel the edge of the liver press against your fingers. A normal
liver is not tender.
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Physical Examination of the Abdomen: Deep PalpationPalpating the liver-(hooking technique)
• The “hooking technique” can be helpful when a patient is obese.
• Place both hands, side by side, on the right abdomen below the border of liver
dullness.
• Press in with the fingers and go up toward the costal margin. Ask the patient to
take a deep breath. The liver edge should be palpable under the finger pads of
both hands.
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Physical Examination of the Abdomen: Deep PalpationPalpating the spleen
•
•
•
•
Use your left hand to lift the lower rib cage and flank.
Press down just below the left costal margin with your right hand.
Ask the patient to take a deep breath.
The spleen is not normally palpable on most individuals.
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Special Tests-Shifting Dullness
This is a test for peritoneal fluid (ascites).
(Ascites: is a gastroenterological term for an accumulation of fluid in the
peritoneal cavity)
• Percuss the patient's abdomen to outline areas of dullness and tympany.
• Position the patient on the right or left side.
• Percuss and again outline areas of dullness and tympany. If the dullness has
shifted to areas of prior tympany, the patient may have excess peritoneal fluid.
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Special Tests-Rebound TendernessThis is a test for peritoneal irritation and appendicitis.
(Appendicitis a condition characterized by inflammation of the appendix)
• Warn the patient what you are about to do (should be in supine position).
• Press deeply on the lower right side of the abdomen with your hand (at a 90degree angle).
• After a moment, quickly release pressure.
• Ask if the client feels any pain. Normally, the client feels the pressure but no
pain.
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Special Tests-Rovsing's sign
This is a test for appendicitis.
• Applying hand pressure to the lower left side of the abdomen.
• Pain felt on the lower right side of the abdomen upon the release of pressure on
the left side indicates the presence of Rovsing's sign.
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Special Tests-Psoas Sign
This is a test for appendicitis.
• Place your hand above the patient's right knee.
• Ask the patient to flex the right hip against resistance.
• Increased abdominal pain indicates a positive psoas sign.
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Special Tests-Obturator Sign
This is a test for appendicitis.
• Raise the patient's right leg with the knee flexed.
• Rotate the leg internally at the hip.
• Increased abdominal pain indicates a positive obturator sign.
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Special Tests-Costovertebral angle
tenderness (CVA)
(The costovertebral angle is the area on the lower back formed by the vertebral
column and downward curve of the last posterior rib)
CVA tenderness is often associated with renal disease.
• Have the patient in sitting position.
• Use the heel of your closed fist to strike the patient firmly over the
costovertebral angles.
• Compare the left and right sides.
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