Abdomen

Chapter 22: Abdomen Overview

Focus on the abdomen's internal anatomy and examination techniques.

Internal Anatomy

  • Peritoneum: Serous membrane lining the abdominal cavity.

  • Major Organs and Their Functions:

    • Spleen: Filters blood, recycles iron, and helps fight infections.

    • Liver: Metabolizes substances, detoxifies harmful compounds, produces bile for digestion, and stores vitamins and glycogen.

    • Stomach: Breaks down food with acids and enzymes, converting it into a semi-liquid form (chyme).

    • Gallbladder: Stores and concentrates bile, releasing it into the small intestine to aid in digestion of fats.

    • Small intestine: Major site for digestion and absorption of nutrients and minerals from food.

    • Large intestine components:

      • Descending colon: Absorbs remaining water and salts; prepares waste for elimination.

      • Cecum: Initial section of the large intestine, absorbing fluids and salts from solid waste.

      • Appendix: Traditionally thought to have no function, but may play a role in immune function.

      • Sigmoid colon: Final part of the large intestine leading to the rectum, stores fecal matter until elimination.

    • Bladder: Stores urine produced by the kidneys until it is excreted.

    • Pubic symphysis: Cartilage joint that provides stability and flexibility to the pelvis.

Viscera:

  • Organs within the abdominal cavity.

Anatomic Locations of Abdominal Quadrants

  • Upper Quadrants

    • Right Upper Quadrant (RUQ): Contains liver, gallbladder, duodenum, head of pancreas, right kidney and adrenal gland, part of ascending and transverse colon.

    • Left Upper Quadrant (LUQ): Contains stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal gland, part of transverse and descending colon.

  • Lower Quadrants

    • Right Lower Quadrant (RLQ): Contains appendix, right ovary and tube, right ureter, right spermatic cord.

    • Left Lower Quadrant (LLQ): Contains sigmoid colon, left ovary and tube, left ureter, left spermatic cord.

Developmental Competence

  • Newborns: Prominent umbilical cord on the abdomen.

  • Early Childhood: Abdomen less muscular; easier to palpate organs.

  • Older Adults: Salivation decreases leading to dry mouth and taste; delayed esophageal emptying and gastric acid secretion; increased incidence of gallstones; decreased liver size while normal functions are maintained, but impaired drug metabolism; reports of constipation are common.

Subjective Data Collection

  • Key areas to assess: Appetite, dysphagia, food intolerance, abdominal pain, nausea and vomiting, bowel habits, past abdominal history, medications, nutritional assessment.

Nurse Check: Nutritional Assessment

  • Type of assessment: 24-hour recall, food frequency, food diary, direct observation.

Additional History for Infants and Children

  • Breastfeeding or bottle-feeding status.

  • Infant's tolerance of formula.

  • Eating frequency for toddlers/children.

  • Stools per day/week.

  • Hydration (water and juice intake).

Preparation for Abdomen Examination

  • Expose abdomen, covering genitalia and breasts in female patients.

  • Position patient for comfort to enhance relaxation of the abdominal wall.

  • Empty bladder before examination (specimen saved if needed).

  • Warm stethoscope; examine painful areas last.

Exam Order:

  • Auscultate before palpation and percussion.

Nurse Check: Sequence of Techniques Order:

  • Inspection

  • Auscultation

  • Percussion

  • Palpation

  • (Do not follow: percussion then auscultation.)

Inspection of the Abdomen

  • Key Elements: Contour and shape, symmetry, umbilicus (should be midline and inverted without discoloration or inflammation), skin (look for pulsations/movements).

  • Contour Types: Flat, scaphoid, rounded, protuberant.

Auscultation of Bowel and Vascular Sounds

  • Principles: Auscultate first to prevent influencing peristalsis. Use diaphragm for bowel sounds; start in RLQ.

  • Findings: Normoactive, hypoactive, hyperactive, absent.

  • Vascular Sounds: Use bell of stethoscope; check aorta, renal arteries, iliac, and femoral arteries for hypertension.

Percussion Techniques

  • Purpose: Assess density, locate organs, and screen for fluid/masses.

  • Sounds: Tympany should dominate in supine position. Dullness over organs (liver, spleen).

  • Liver Span Assessment: Measure liver height in right midclavicular line via percussion. Normal span: 6 to 12 cm.

  • Splenic Dullness: Percuss from 9th to 11th intercostal space to locate spleen. Normal area of dullness: < 7 cm in adults.

  • Costovertebral Angle Tenderness: Assess by percussing over 12th rib at costovertebral angle; normal response is a thud without pain. Pain suggests kidney inflammation.

Light Palpation

  • Technique: Depress skin about 1 cm with first four fingers. Aim: Form overall impression of skin and superficial musculature. Save examination of tender areas until last. Assess for guarding (voluntary vs. involuntary).

Deep Palpation

  • Technique: Push down about 2 to 3 inches. Use bimanual technique if abdomen is large/obese. Document findings: mass location, size, shape, consistency, surface, tenderness.

Palpation of Major Organs

  • Liver: Ask patient to take a deep breath; feel the liver's edge during inhalation.

  • Spleen: Not normally palpable; requires enlargement to feel. Use left hand behind ribs and right hand on LUQ to assess.

  • Kidney: Usually not palpable; use hands in a “duck-bill” position.

  • Aorta: Palpate aortic pulsation slightly left of midline in upper abdomen. Normal width: 2.5 to 4 cm.

Rebound Tenderness

  • Assess when patient reports pain; check at end of assessment.

  • Blumberg sign: Pain on RLQ when palpating LLQ indicates appendicitis.

Abnormal Findings

  • Possible issues: Ascites, umbilical hernia, epigastric hernia, incisional hernia, diastasis recti, arterial bruit, enlarged liver, spleen, or kidney.

Nurse Check: Appendicitis Assessment

  • Ask patient to point to pain location; palpate that area first. Do not palpate abdomen first if eliciting pain.

Question: Abdominal Bruit

  • A bruit in the epigastric area may indicate an abdominal aortic aneurysm.