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Where does the posterior abdomen extend from?
Vertebral column and paravertebral muscles
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Where does the anterior aboment extend from?
Extends from the diaphargm to symphysis pubis
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Th abd wall muscles are joined at the midline by what?
Tendon seam (linea alba= white line)
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What are the exterior abd wal muscles?
rectus abdominis and external oblique
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What are the underlying muscles of the abd wall?
Internl oblique and transversus
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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
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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
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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
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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
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Where is the epigastric region
Midline, between costal margins
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Where is the umbilica region
Around the umbilicus
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Where is the suprapubic region
- Above the pubic bone
- E.g. full bladder--> suprapubic distension
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Where is the aorta located?
Slightly left of the midline in upper abd
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What does the aorta artery bifurcate into at the coastal margin?
Right and left renal arteries
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What does the aorta artery bifurcate into 2cm below the umbilicus?
Right and left iliac arteries
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What does the aortic artery branch into at the groin?
Femoral arteries
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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
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What are solid organs?
- Liver
- Pancreas
- Spleen
- Kidneys
- Adrenal glands
- Ovaries
- Uterus
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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)
- Bladder
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What does the right rib cage protect?
liver, gallbladder, right kidney
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What does the left rib cage protect?
Stomach, spleen, left kidneys
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How may arteries and veins are in a newborn umbilical cord and what does deviation indicate?
- 2 arteries
- 1 vein
- congenital anomaly
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Does the liver take up more or less space in infants and newborns?
More
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Does the bladder lie higher or lower in the abd int he newborn and infant?
Higher. Between the symphysis pubis and umbilicus
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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
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What is heartburn in the pregnant women related to?
Increased esophageal reflux secondary to increased pressure from displaced abd
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Pregnancy: increased or decreased GI motiity?
Decreased--> Constipation
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Pregnancy: Increased or decreased pressure on venous system?
Increased--> Hemorrhoids, varicosities
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Effects of enlarging uterus on bowel sounds in pregnancy?
Decreased BS r/t displacement of intestines upward and posterior
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Skin changes in the pregnant woman
Striae and linea nigra
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Aging adult: increase or decrease adipose on abd
increased (redistribution of fat)
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Aging adult: effect on salivation and taste
decreased saliation and decreased taste
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Aging adult: effects of gastric emptying
- Delayed, which increased risk for aspiration when supine
- Also increased constipation
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Aging adult: effects of gastric acid secretion
decreased, which may cause altered B12 absorption, Fe deficiency anemia and calcium malabsorption
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Aging adult: effects of gallstone incidences
Increased
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Aging adult: effects on liver
decreased which may impair drug metabolism. Start slow and go slow
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Anorexia
Decreased desire for food
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Dysphagia
Difficulty swallowing indicating a problem with throat or esophagus
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Odynophagia
Pain upon swallowing
-
Lactose intolerane
- Gastric bloating r/t decreased lactase.
- This is not an allergic response, but rather an intolerance. Subsequent exposure will not be harmful
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Referred pain:
1. Appendicitis
2. Cholecystitis
3. Diverticulitis
- 1. Periumbilical to RLQ
- 2. RUQ to right shoulder or right subscapular region
- 3. LLQ
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Referred pain:
4. Gastritis
5. Gastric ulcer
6. Gastroesophagal reflux
- 4. epigastric
- 5. LUQ
- 6. midepigastric to jaw
-
Referred pain:
7. Hepatitis/hepatomegaly
8. Leaking abd aneurysm
9. Pancreatitis
- 7. RUQ
- 8. midline and penetrates to back
- 9. LUQ and epigastric to left shoulder to lower back
-
Referred pain:
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
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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
-
Melena
- Black tarry stool--> UGI bleed
- E.g. ulcer
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Black stools
Fe, bismuth (peptobismal)
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Hematochezia
Maroon stools, usually LGI bleed. May be UGI bleed if rapid motility present
-
BRBPR
- Bright red blood per rectum
- Lower GIB
- Ex: Hemorrhoids
-
Clay colored stools
Biliary obstruction
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Decreased caliber of stools
Pencil thin--> obstruction (Ca), decreased fiber
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Distention (7 Fs)
- Fluid
- Feces
- Flatus
- Fat
- Fetus
- Fibroid
- Fetal mass
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IMB
- Inflammatory bowel disease
- Colitis and Crohns disease (increased risk of colon cancer)
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Effects of nicotine
increased incidence of peptic ulcer
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Diastis recti (linear buldge) with sit-up inspection
Nml
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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
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Demeanor with colicky pain
Restless
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Demeanor with peritoneal pain
Absolute stillness, knees flexed, grimaces, rapid uneven respirations
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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?
Liver disease
-
What may prominent dilated veins indicate?
portal HTN (cirrhosis, ascites) or inferior vena cava obstruction
-
Borborygmi
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
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Liver span
- RMCL (6-12cm)- 5th ICS to right costal margin
- Mid sternal line (4-8cm) usually not measured
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Hepatomegaly
- Enlargement. Greater than 12cm at RMCL
- COPD may displace the liver downward
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Spleen percussion
- Dull noted 9th to 11th ICS and lateral of left MAL.
- Usually <7cm
- Enlarged spleen (extends to MAL)- mononucleosis, trauma, leukemia
-
CVAT percussion
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
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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
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Rebound tenderness
- 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)
-
Obturator test
Positive test (pain occurs with passive internal/external roation of the leg when the leg is flexed 90 degrees at the hip)
-
Murphy's sign
- Cholecystitis.
- Positive test (inspiratory arrest with deep palpation under liver)
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Umbilical hernia in infant/child
- may appear in 2-3wks
- reseaches max size 1 month (2.5cm)
- disappears by 1yo
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Diastasis recti
Separation of rectus abd muscles causing buldge along midline
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Stool in infant/child
- first 24h sticky, greenish black meconium
- By 4th day:
- - breast- golden/yellow, pasty
- - formula- brown-yellow, firmer
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Hepatomegaly
- 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)
-
Enlarged kidney
- Hydronephrosis (back up fluid in kidney r/t distal obstruction)
- Cyst or neoplasm
-
Aortic aneurysm
95% located near renal arteries
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