ASSESSING THE ABDOMEN

Abdomen

Abdomen

bordered superiorly by the costal margins, inferiorly by the symphysis pubis and inguinal canals, and laterally by the flanks.

abdominal quadrants, the abdominal wall muscles, and the internal anatomy of the abdominal cavity

It is important to understand the anatomic divisions known as the abdominal quadrants, the ________________________________________________ in order to perform an adequate assessment of the abdomen.

imaginary vertical line

The quadrants are determined by an ____________________________________ (midline) extending from the tip of the sternum (xiphoid) through the umbilicus to the symphysis pubis.

epigastric, umbilical, hypogastric or suprapubic

Three of these regions are still commonly used to describe abdominal findings

abdominal wall musculature

The abdominal contents are enclosed externally by the ______________________________________, which includes three layers of muscle extending from the back, around the flanks, to the front.

Rectus Abdominis

Connective tissue from these muscles extends forward to encase a vertical muscle of the anterior abdominal wall called the

linea alba

The joining of these muscle fibers and aponeuroses at the midline of the abdomen forms a white line called

linea alba

extends vertically from the xiphoid process of the sternum to the symphysis pubis.

Abdominal Wall Muscles

protect the internal organs and allow normal compression during functional activities such as coughing, sneezing, urination, defecation, and childbirth.

peritoneum

A thin, shiny, serous membrane called the _________________ lines the abdominal cavity (parietal peritoneum) and also provides a protective covering for most of the internal abdominal organs (visceral peritoneum).

GURL

Within the abdominal cavity are structures of several different body systems:

abdominal viscera

Within the abdominal cavity are structures of several different body systems: gastrointestinal, reproductive (female), lymphatic, and urinary. These structures are typically referred to as the ______________________ and can be divided into two types: solid viscera and hollow viscera

Solid Viscera

are those organs that maintain their shape consistently

Hollow Viscera

consist of structures that change shape depending on their contents.

Solid Viscera

liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus.

Hollow Viscera

These include the stomach, gallbladder, small intestine, colon, and bladder.

Liver

the largest solid organ in the body.

Liver

It is located below the diaphragm in the RUQ of the abdomen.

Liver

It is composed of four lobes that fill most of the RUQ and extend to the left midclavicular line.

F, soft

T OR F:
If palpable, the liver has a firm consistency.

Pancreas

located mostly behind the stomach deep in the upper abdomen.

Pancreas

It is a long gland extending across the abdomen from the RUQ to the LUQ.

endocrine gland and an accessory organ of digestion

The pancreas has two functions: it is an _______________________________________________.

7cm

The spleen is approximately ___________ wide and is located above the left kidney just below the diaphragm at the level of the ninth, tenth, and eleventh ribs.

Spleen

This soft, flat structure is normally not palpable.

left costal margin

In some healthy clients, the lower tip of the spleen can be felt below the

Spleen

functions primarily to filter the blood of cellular debris, to digest microorganisms, and to return the breakdown products to the liver.

Kidneys

are located high and deep under the diaphragm.

10 × 5 × 2.5 cm

These glandular, bean-shaped organs (kidneys) measuring approximately _________________________ are considered posterior organs and approximate with the level of the T12 to L3 vertebrae.

T12 to L3

These glandular, bean-shaped organs (kidneys) measuring approximately 10 × 5 × 2.5 cm are considered posterior organs and approximate with the level of the _____________ vertebrae.

posterior rib cage

The tops of both kidneys are protected by the

costovertebral angle

Kidney tenderness is best assessed at the

right kidney

is positioned slightly lower because of the position of the liver.

Kidneys

The primary function of the _______________ is filtration and elimination of metabolic waste products.

T

T OR F:
The kidneys also play a role in blood pressure control and maintenance of water, salt, and electrolyte balances.

Pregnant Uterus

may be palpated above the level of the symphysis pubis in the midline.

Ovaries

are located in the RLQ and LLQ and are normally palpated only during a bimanual examination of the internal genitalia.

Stomach

The abdominal cavity begins with the

Stomach

It is a distensible, flask-like organ located in the LUQ just below the diaphragm and between the liver and spleen.

store, churn, digest food

The stomach’s main function is to

Gallbladder

a muscular sac approximately 10 cm long, functions primarily to concentrate and store the bile needed to digest fat.

Gallbladder

It is located near the posterior surface of the liver lateral to the mid-clavicular line.

Small Intestine

is actually the longest portion of the digestive tract (approximately 7.0 m long) but is named for its small diameter (approximately 2.5 cm).

digestion and absorption

Two major functions of the small intestine are ______________________________ of nutrients through millions of mucosal projections lining its walls.

Small Intestine

lies coiled in all four quadrants of the abdomen, is not normally palpated.

Large Intestine or Colon

has a wider diameter than the small intestine (approximately 6.0 cm) and is approximately 1.4 m long.

ileocecal valve

Large Intestine originates in the RLQ, where it attaches to the small intestine at the _____________________.

Ascending Colon

extends up along the right side of the abdomen.

Transverse Colon

At the junction of the liver in the RUQ, it flexes at a right angle and becomes the

Descending Colon

The transverse colon runs across the upper abdomen. In the LUQ near the spleen, the colon forms another right angle then extends downward along the left side of the abdomen as the

sigmoid colon

At this point, it curves in toward the midline to form the _______________________ in the LLQ.

sigmoid colon, cecum and ascending colon

The ________________________ is often felt as a firm structure on palpation, whereas the _____________________________may feel softer.

T

T OR F:
The transverse and descending colon may also be felt on palpation.

Colon

functions primarily to secrete large amounts of alkaline mucus to lubricate the intestine and neutralize acids formed by the intestinal bacteria.

Water

is also absorbed through the large intestine, leaving waste products to be eliminated in stool.

Urinary Bladder

a distensible muscular sac located behind the pubic bone in the midline of the abdomen, functions as a temporary receptacle for urine.

urine

A bladder filled with ____________ may be palpated in the abdomen above the symphysis pubis.

Abdominal Organs

are supplied with arterial blood by the abdominal aorta and its major branches

aorta

Pulsations of the __________ are frequently visible and palpable midline in the upper abdomen.

umbilicus

The aorta branches into the right and left iliac arteries just below the

Abdominal Pain

occurs when specific digestive organs or structures are affected by chemical or mechanical factors such as inflammation, infection, distention, stretching, pressure, obstruction, or trauma.

Acute Pancreatitis

produces sudden onset of pain

Pancreatic Cancer

may be gradual or recurrent.

burning sensation

A ______________________ in the esophagus may occur with gastric acid reflux after eating.

Peptic Ulcers

Dull or burning pain located between the breasts and umbilicus may occur with

referred pain

pain from organs within the abdomen may be felt in other areas outside the abdomen, for example, pancreatic inflammation may be felt in the back. This is called _____________________ because the pain is not felt at its source.

Indigestion or Pyrosis

often described as heartburn, may be an indication of acute or chronic gastric disorders including hyperacidity, gastroesophageal reflux disease (GERD), peptic ulcer disease, and stomach cancer.

GERD

The main symptom of ___________ in adults is frequent heartburn, which is acid indigestion, a burning-type pain in the lower part of the mid-chest, behind the breastbone, and in the mid-abdomen.

Hematemesis

Vomiting with blood.

Nausea

may reflect gastric dysfunction and is also associated with many digestive disorders and diseases of the accessory organs, such as the liver and pancreas, as well as with renal failure and drug intolerance.

Nausea

may also be precipitated by dietary intolerance, psychological triggers, or menstruation.

Nausea. morning sickness

may also occur at particular times such as early in the day with some pregnant clients (________________________), after meals with gastric disorders, or between meals with changes in blood glucose levels.

Motion Sickness

causes nausea and vomiting for many people when the inner ear, the eyes, and other areas of the body that detect motion perceive that the body is moving, while the other parts do not sense the motion

Vomiting

is associated with impaired gastric motility or reflex mechanisms.

emesis

Description of vomitus (_______________) is a clue to the source.

Bright Hematemesis

is seen with bleeding esophageal varices and ulcers of the stomach or duodenum.

Loss of appetite or Anorexia

a general complaint often associated with digestive disorders, chronic syndromes, cancers, and psychological disorders.

T

T OR F:
Older adult clients may experience a decline in appetite from various factors such as altered metabolism, decreased taste sensation, decreased mobility, and, possibly, depression. If appetite declines, the client’s risk for nutritional imbalance increases.

2-3 times/day, 3 times/week

Changes in bowel patterns must be compared to usual patterns for the client. Normal frequency varies from

Constipation

usually defined as a decrease in the frequency of bowel movements or the passage of hard and possibly painful stools.

Diarrhea

defined as frequency of bowel movements producing unformed or liquid stools.

Bloody and mucoid stools

are associated with inflammatory bowel diseases (e.g., ulcerative colitis, Crohn’s disease)

malabsorption syndromes

clay-colored, fatty stools may be from

UTIs

may become recurrent and chronic.

Alcohol Ingestion

can affect the GI tract through immediate and long-term effects on such organs as the stomach, pancreas, and liver.

Regular Exercise

promotes peristalsis and thus regular bowel movements.

Brain Gut Axis

Some people who have high stress levels actually feel it in the gut, known informally as the

Irritable Bowel Syndrome (IBS)

can be disabling, limiting one’s ability to work, attend social events, or even travel short distances

Visceral Pain

when hollow abdominal organs—such as the intestines—become distended or contract forcefully, or when the capsules of solid organs such as the liver and spleen are stretched.

Visceral Pain

Poorly defined or localized and intermittently timed, this type of pain is often characterized as dull, aching, burning, cramping, or colicky.

Parietal Pain

when the parietal peritoneum becomes inflamed, as in appendicitis or peritonitis.

Parietal Pain

This type of pain tends to localize more to the source and is characterized as a more severe and steady pain.

Referred Pain

occurs at distant sites that are innervated at approximately the same levels as the disrupted abdominal organ.

Referred Pain

This type of pain travels, or refers, from the primary site and becomes highly localized at the distant site. The accompanying illustrations show common clinical patterns and referents of pain.

Peptic Ulcers

form in the lining of the esophagus, stomach, or small intestine when acid eats away the protective mucous covering and erodes the underlying lining of these organs.

H. Pylori

Often the bacterium ______________ is active in causing the ulcer.

Ulcers

can be quite painful and can bleed.

Gallbladder Cancer

is uncommon and is easily treatable when discovered in early stages, but it is highly fatal if discovered when advanced.

Cholelithiasis

Gallstones are also called

T

T OR F:
High rates of GBC are found in South American countries (especially Chile, which has the highest mortality rates from GBC in the world), India, Pakistan, Japan, Korea, Czech Republic, Slovakia, and Spain.