Where does the posterior abdomen extend from?
Vertebral column and paravertebral muscles
Where does the anterior aboment extend from?
Extends from the diaphargm to symphysis pubis
Th abd wall muscles are joined at the midline by what?
Tendon seam (linea alba= white line)
What are the exterior abd wal muscles?
rectus abdominis and external oblique
What are the underlying muscles of the abd wall?
Internl oblique and transversus
What is in the RUQ?
- 1. Liver
- 2. Gallbladder
- 3. Pylorus
- 4. Duodenum
- 5. Head of pancreas
- 6. Part of right kidney and adrenal gland
- 7. Hepatic flexure of colon
- 8. Part of ascending and transverse colon
What is in the LUQ?
- 1. Stomach
- 2. Spleen
- 3. Left lobe of the liver
- 4. Body of the pancreas
- 5. Part of left kidney and adrenal gland
- 6. Spenic flexure of colon
- 7. Part of transverse and descending colon
What is in the RLQ?
- 1. Cecum
- 2. Appendix
- 3. Part of ascending colon
- 4. Right ovary and fallopian tube
- 5. Lower pole of right kidney
- 6. Right ureter
- 7. Right spermatic cord
- 8. Bladder
- 9. Uterus
What is in the LLQ?
- 1. Part of descending colon
- 2. Sigmoid colon
- 3. Left ovary and fallopian tube
- 4. Lower pole of left kidney
- 5. Left ureter
- 6. Left spermatic cord
- 7. Badder
- 8. Uterus
Where is the epigastric region
Midline, between costal margins
Where is the umbilica region
Around the umbilicus
Where is the suprapubic region
- Above the pubic bone
- E.g. full bladder--> suprapubic distension
Where is the aorta located?
Slightly left of the midline in upper abd
What does the aorta artery bifurcate into at the coastal margin?
Right and left renal arteries
What does the aorta artery bifurcate into 2cm below the umbilicus?
Right and left iliac arteries
What does the aortic artery branch into at the groin?
Where is the liver located?
Fills RUQ and extends into left MCL. Lower border may be palpable
Where is the spleen located?
- Lays under the diaphargm on the postero-lateral abd wall.
- ays oblique and parallel with the 10th rib, ateral to the MAL
- Usually not palpable
Where are the kidneys located?
- Retroperitoneal, posterior to abd at costovertebral angle
- Right kidney is apprx 2cm ower than the left kidney due to the liver
- May be palpable
What are solid organs?
- Adrenal glands
What are hallow organs?
- Stomach (below left diaphargm behind rib cage)
- Gallbladder (under liver, lateral to right MCL)
- Small intestine (in all 4 quads)
- Colon (in all 4 quads)
What does the right rib cage protect?
liver, gallbladder, right kidney
What does the left rib cage protect?
Stomach, spleen, left kidneys
How may arteries and veins are in a newborn umbilical cord and what does deviation indicate?
- 2 arteries
- 1 vein
- congenital anomaly
Does the liver take up more or less space in infants and newborns?
Does the bladder lie higher or lower in the abd int he newborn and infant?
Higher. Between the symphysis pubis and umbilicus
What is morning sickness related to?
When does it occur?
And in what percentage of individuals?
- Increase HCG (human chorionic gonadotropin)
- First trimester
- 50-75% individuals
What is heartburn in the pregnant women related to?
Increased esophageal reflux secondary to increased pressure from displaced abd
Pregnancy: increased or decreased GI motiity?
Pregnancy: Increased or decreased pressure on venous system?
Increased--> Hemorrhoids, varicosities
Effects of enlarging uterus on bowel sounds in pregnancy?
Decreased BS r/t displacement of intestines upward and posterior
Skin changes in the pregnant woman
Striae and linea nigra
Aging adult: increase or decrease adipose on abd
increased (redistribution of fat)
Aging adult: effect on salivation and taste
decreased saliation and decreased taste
Aging adult: effects of gastric emptying
- Delayed, which increased risk for aspiration when supine
- Also increased constipation
Aging adult: effects of gastric acid secretion
decreased, which may cause altered B12 absorption, Fe deficiency anemia and calcium malabsorption
Aging adult: effects of gallstone incidences
Aging adult: effects on liver
decreased which may impair drug metabolism. Start slow and go slow
Decreased desire for food
Difficulty swallowing indicating a problem with throat or esophagus
Pain upon swallowing
- Gastric bloating r/t decreased lactase.
- This is not an allergic response, but rather an intolerance. Subsequent exposure will not be harmful
- 1. Periumbilical to RLQ
- 2. RUQ to right shoulder or right subscapular region
- 3. LLQ
5. Gastric ulcer
6. Gastroesophagal reflux
- 4. epigastric
- 5. LUQ
- 6. midepigastric to jaw
8. Leaking abd aneurysm
- 7. RUQ
- 8. midline and penetrates to back
- 9. LUQ and epigastric to left shoulder to lower back
10. Perforated duodenal ulcer
11. Renal/ureteral stone
12. Salpingitis, ovarian cyst, ruptured ectopic pregnancy
- 10. RUQ to shoulders
- 11. RLW or LLQ to groin
- 12. RLQ tor LLQ
Meds in the older adult
Even low doses may be harmful for the elderly. Increased risk for GI bleed. Always take with food to decrease risk for gastritis/GI bleed
- Black tarry stool--> UGI bleed
- E.g. ulcer
Fe, bismuth (peptobismal)
Maroon stools, usually LGI bleed. May be UGI bleed if rapid motility present
- Bright red blood per rectum
- Lower GIB
- Ex: Hemorrhoids
Clay colored stools
Decreased caliber of stools
Pencil thin--> obstruction (Ca), decreased fiber
Distention (7 Fs)
- Fetal mass
- Inflammatory bowel disease
- Colitis and Crohns disease (increased risk of colon cancer)
Effects of nicotine
increased incidence of peptic ulcer
Diastis recti (linear buldge) with sit-up inspection
Inspection: aortic pulsation
May see some pulsation. Marked pulsations may indicate an aneurysm
Inspection: peristalsis during inspection
- Visible in thin person
- May indicate early bowel obstruction
Demeanor with colicky pain
Demeanor with peritoneal pain
Absolute stillness, knees flexed, grimaces, rapid uneven respirations
What would an everted umbilicus mean?
Ascites or underlying mass, pregnancy
What would striae mean?
- Stretch marks
- Color initially pink or blue, then white.
- Purple striae r/t Cushing syndrome (excess adrenocortical hormone)
What is ascites associated with?
What may prominent dilated veins indicate?
portal HTN (cirrhosis, ascites) or inferior vena cava obstruction
Growling sounds indicating hunger
Nml freq bowel sounds
5-30 min. Listen up to 5 minutes until heard
Tinkling bowel sounds
may indicate early bowel obstruction
Paralytic ileus (absence of GI motility and bowel sounds)
May take up to 48 hours for BS to return
Tympanny with percussion
- generally predominates
- r/t gas in small and large intestine
Dullness with percussion
liver, distended bladder, adipose tissue, fluid, feces, mass
Hyperresonance with percussion
present eith gaseous distention
- RMCL (6-12cm)- 5th ICS to right costal margin
- Mid sternal line (4-8cm) usually not measured
- Enlargement. Greater than 12cm at RMCL
- COPD may displace the liver downward
- Dull noted 9th to 11th ICS and lateral of left MAL.
- Usually <7cm
- Enlarged spleen (extends to MAL)- mononucleosis, trauma, leukemia
direct or indirect percussion over 12th rib elicits pain (may indicate kidney infection)
Special tests: fluid wave (not reliable. need US)
tap abd and feel wave on opposite side if ascites present
Special tests: shifting dullness (not reliable, need US)
- Percussion sounds change wil position change
- Spine- Fluid dispersed to both sides
- Lateral- Fluid drains to side causing shifting dullness
Fxn of spleen
- Forms monocytes and lymphocytes
- Stores RBC and releases into circulation if needed
- Filters old RBC from blood
What to do is palpate spleen
- Must be 3x nml size to palpate
- Stop palpation if enlarged because you may rupture
- May extend to LLQ
Palpation: Prominent lateral pulsation of aorta
- May indicate AAA
- If >4cm AAA may be indicated
- Tests for peritoneal inflammation
- Deep palpation with quick withdrawal (hand at 90 degree angle)
- Positive test (pain with quick release)
Iliopsoas muscle test
- Assess with patient in supine position
- Positive test (SLR with resistance causes RLQ pain)
Positive test (pain occurs with passive internal/external roation of the leg when the leg is flexed 90 degrees at the hip)
- Positive test (inspiratory arrest with deep palpation under liver)
Umbilical hernia in infant/child
- may appear in 2-3wks
- reseaches max size 1 month (2.5cm)
- disappears by 1yo
Separation of rectus abd muscles causing buldge along midline
Stool in infant/child
- first 24h sticky, greenish black meconium
- By 4th day:
- - breast- golden/yellow, pasty
- - formula- brown-yellow, firmer
- Nontender smooth liver (fatty infiltration, portal obstruction or cirrhosis, high onstruction of IVC and lymphocytic leukemia)
- Tender enlargment (CHF, acute hepatitis or hepatic abscess)
- Nodular liver (late cirrhosis, metastatic cancer, tertiary syphylis)
- Small liver (end stage liver disease)
- Hydronephrosis (back up fluid in kidney r/t distal obstruction)
- Cyst or neoplasm
95% located near renal arteries