Transcript Abdomen2
The Abdomen
1. Anatomy & Physiology
2. History
3. Examination & Findings
4. Common Abnormalities
The Abdomen
Anatomy and
Physiology
Anatomy and Physiology
The Gastrointestinal tract
Mouth Esophagus Stomach
Small Intestines: Duodenum Jejunum Ileum
Large Intestines: Cecum Colon
Sigmoid Colon Rectum Anus
Function & Control
Ingest and Digest Food
Absorb Nutrients, Electrolytes and
Water
Excrete Waste products
Controlled by Autonomic Nervous
System
The Liver
Location: right upper quadrant
Weight: 3 lbs
Composition: four lobes containing lobules, the
functional units of the liver
Blood supply: hepatic artery brings blood from the
aorta directly to the liver.
The portal vein brings blood from the digestive tract
and the spleen to the liver
Three hepatic veins empty blood from the liver into
the inferior vena cava
Liver Function
Metabolism of carbohydrates, fats and protein
Glucose is converted and stored as Glycogen
Amino acids are broken down and their waste
products converted to urea for excretion
Amino acids can be converted to glucose:
gluconeogenesis
Fats arriving as fatty acids are oxidized into
carbon components
Liver Function
Cholesterol is used to form bile salts
Storage of vitamins and iron
Detoxification, production of antibodies,
conjugation & excretion of steroid hormones
Production of prothrombin, fibrinogen and
other substances for coagulation
The liver is responsible for the majority of the
proteins circulating in the plasma
The Gallbladder
Location: under the inferior surface of the liver
in the right upper quadrant
Function: concentration and storage of bile
from the liver
Cholecystokinin: a hormone produced by the
duodenum: causes bile to be released in the
common bile duct and into the duodenum
Bile maintains the alkaline pH of the small
intestines so fats can be emulsified in order to
be absorbed
The Pancreas
Location: behind and beneath the stomach,
epigastric region and left upper quadrant
Exocrine function: production of digestive
juices containing inactive enzymes for the
breakdown of proteins, fats and carbohydrates
The pancreatic duct empties into the
duodenum, alongside the common bile duct
The digestive enzymes become activated in
the duodenum
The Pancreas
Endocrine function: the production of the
hormones insulin and glucagon
Produced by the islet cells
Secreted directly into the blood, to regulate the
body’s level of glucose.
The Spleen
Location: left upper quadrant, above the left
kidney, below the diaphragm
Composition: lymphoid tissue
Function: filter blood as part of the
reticuloendothelial system (RES): defense
against infection and disposal of products of
the breakdown of cells
Manufactures lymphocytes and monocytes
Storage area for blood
Kidneys Posterior View
The Kidneys, Ureters, and Bladder
Function: reabsorption of electrolytes, small
proteins and water, The kidneys control the
water and electrolyte balances of the body
Elimination of waste products in urine
Endocrine Gland: produces renin, important in
the control of aldosterone secretion
Erythropoietin production:regulates the red
blood cell production
Production of the active form of vitamin D
The Kidneys, Ureters, and Bladder
Urine passes into the renal pelvis via the
collecting tubules and then into the ureter
Peristaltic waves move the urine into a
reservoir: the bladder
The Bladder has a capacity of 400-500 ml
Urine then is eliminated from the body via the
urethra
The Abdomen
History
Present Problem
Abdominal Pain:
Onset and Duration
Character
Location
Associated symptoms: nausea,vomiting, diarrhea,
constipation, flatus, belching, jaundice
Relationship: body position, inspiration, food intake,
menstrual cycle, urination, defecation, time of day
Referred Pain
Present Problem
Indigestion:
Character: fullness, heartburn, discomfort, belching,
loss of appetite
Association: with food intake, time, amount, type of
food intake
Onset of symptoms: sudden, gradual, day or night
Symptom relieve: rest, antacids
Medication: OTC and prescribed
Nausea: stimuli, with or without vomiting
Present Problem
Vomiting
Character: nature, quantity, duration,
frequency, ability to keep liquids down
Relationship: meals,change in appetite, fever,
weight loss
Present Problem
Diarrhea
Character: copious, watery, explosive, color,
presence of blood, number of times a day
Associated symptoms: chills, fever, thirst, weight
loss, pain and or cramping, incontinence
Relationship: timing, nature of food intake, stress
Travel History
Medication: OTC or prescribed, laxatives, stool
softeners, antidiarrheals
Present Problem
Constipation
Character: presence of blood: black, bright,
tarry. Alternating with diarrhea, with or without
abdominal discomfort
Pattern: last BM, pain with passage of BM,
changes in pattern
Diet: recent changes in diet
Medication: OTC and prescribed, laxatives,
stool softeners, diuretics, iron
Present Problem
Jaundice
Onset and Duration
Color of stool and urine
Associated with abdominal pain, fever, chills
Exposure to Hepatitis
Medications: high doses of acetaminophen
Past Medical Problem
Gastrointestinal Disorders: Peptic Ulcer
Disease, GERD, inflammatory Bowel Disease,
intestinal Obstruction, Pancreatitis
Hepatitis or Cirrhosis of the Liver
Surgery: abdominal or urinary tract
Major Illness: Cancer, arthritis( steroids/aspirin
use), Kidney Disease, Cardiac Disease
Blood Transfusions
Hepatitis Vaccine
Family History
Gallbladder
Disease
Kidney Disease: kidney stones,
polycystic disease
Malabsorption syndrome: cystic fibrosis,
celiac disease
Personal and Social History
Nutrition: preferences and dislikes, ethnic
foods, religious food restrictions, food
intolerance's, weight gain or loss
Alcohol Intake and use of illegal drugs
Recent physical or psychological changes
Exposure to infectious disease: flu, travel
history
Trauma
The Abdomen
Examination and
Findings
Epigastric Region
1.Pyloric end of
the stomach
Duodenum
Pancreas
Portion of the liver
Umbilical Region
2.Omentum
Mesentery
Transverse Colon
Lower part of the
Duodenum
Jejenum and
Ileum
Hypogastric Region
3.Ileum
Bladder
Uterus in
pregnancy
Right Hypochondriac Region
4.Right lobe of the liver
Gallbladder
Portion of the Duodenum
Hepatic Flexure of the
Colon
Portion of the right Kidney
Suprarenal Gland
Left Hypochondric Region
5.Stomach
Spleen
Tail of the Pancreas
Splenic Flexure of the
Colon
Upper pole of the left
Kidney
Suprarenal Gland
Right Lumbar Region
6.Ascending Colon
Lower half of the
right Kidney
Portion of the
Duodenum and
Jejunum
Left Lumbar Region
7.Descending Colon
Lower half of the left
Kidney
Portion of the
Duodenum and
Jejunum
Right Inguinal Region
8.Cecum
Appendix
Lower end of Ileum
Right Ureter
Right Spermatic
Cord
Right Ovary
Left Inguinal Region
9.Sigmoid Colon
Left Ureter
Left Spermatic
Cord
Left Ovary
Inspection
Inspect the abdomen for contour, symmetry
and surface motion
Note location and contour of umbilicus
Distention: above umbilicus: gastric dilation,
carcinoma, pancreatic cyst
Below umbilicus: ovarian tumor, pregnancy,
uterine fibroids, distended bladder
Ask patient to take a deep breath on hold it
The Fs of Abdominal Distention
Fat
Fatal
Growth
Feces
Fibroid
Flatus
Fluid
Auscultation
Listen for bowelsounds: note frequency and
character
Borborygmi: stomach growling
High-pitched tinkling sounds: suggestive of
intestinal fluid and air under pressure, in early
obstruction
Decreased Bowelsounds: paralytic ileus and with
peritonitis
Vascular Sounds: listen with the bell for bruits in
the aortic, renal ,iliac and femoral arteries
Auscultation
Auscultation Vascular Sounds
Percusion
Assessment of size and density of abdominal
organs
Listen for tympany ( predominant, produced
by air in stomach and intestines) and
dullness ( over solid organs and masses)
Start with an area of tympany and proceed to
an area of dullness
Percussion
Palpation
To assess the organs and detect masses, fluid, and
areas of tenderness
Stand at the right side of the patient in a suspine
position, with knees bend for relaxation
Make sure your hands are warm
Start with a light systematic palpation of all four
quadrants
Put hand flat on the abdomen and depress the palmar
surface of your fingers one cm, use a dipping motion
Start away from the pain area
Deep Palpation
Use the bimanual method
One hand for push (Top Hand) , the other hand for
feeling (Bottom Hand)
Palpation of the Umbilical Ring
Palpate around the umbilicus
There should be no bulges, nodules or
granulation
The umbilical ring should be round and
regular
A soft center or irregularities are suggestive
for the potential of an umbilical hernia
The umbilicus should not protrude
Palpable Structures
Palpation of the Liver
Place your left hand under the 11th, 12th ribs,
fingers pointing toward the head of the patient
Press upward to elevate the liver toward the
abdominal wall
Have patient breath regular a few times then
task to take a deep breath
Try to feel the edge of the liver against your
fingertips as the diaphragm pushes the liver
down
Liver Palpation
Palpation of the Spleen
Standing on the right side, reach across and place
your left hand beneath the left costovertebral angle
Lift the spleen towards the abdominal wall
Place your right hand with extended fingers on the
patients abdomen below the left costal margin
Press your fingertips inward
Ask the patient to take a deep breath
Try to feel the edge of the spleen as it moves down
Palpation Spleen
Palpation Spleen
Enlarged Liver
Common Abnormalities
Appendicitis:
Epigastric or umbilical pain,
later becomes RLQ pain
McBurney: rebound
tenderness and sharp
pain when McBurney
point is palpated
Associated findings: low
grade fever, N / V
Cholecystitis:
Severe, unrelenting
RUQ pain or
epigastric pain, may
refer to right
subscapular area
Murphy sign: abrupt
stopping of
inspiration upon
palpation of the
gallbladder
Common Abnormalities
Pancreatitis:
Perforated Ulcer:
Sudden, excruciating
abrupt pain in RUQ,
LUQ,epigastric pain,
may refer to both
may be umbilical. Pain
shoulders
can refer to left shoulder
Associated findings:
Grey Turner: ecchymosis
free air and distension
over flanks
with increased
Cullen sign; ecchymosis
resonance over the
around the umbilicus
liver. Tenderness in
Associated findings:
epigastrium, rigid
vomiting, fever, shock
abdomen
Common Abnormalities
Diverticulitis:
epigastric pain, radiating
down the left side of the
abdomen, may refer to the
back
Associated Findings:
flatulence, borborygmi,
diarrhea, dysuria,
tenderness on palpation
Intestinal Obstruction:
abrupt, severe,
spasmodic pain, may
refer to epigastrium,
umbilicus
Associated Findings:
distention, vomiting,
localized tenderness,
visible peristalsis,
absent bowelsounds
or hyperactive
bowelsounds