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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
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Controlled by Autonomic Nervous
System
The Liver
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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
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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
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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
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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
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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.
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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
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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
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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
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The Abdomen
History
Present Problem
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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: GERD
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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
GI Tract
Types of Antacids to Look UP
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OTC (Old Remedy- Tablespoon of Baking Soda)
– Alka-Seltzer
– Tums
– Milk of Magnesia
– Pepto-Bismol
– Gaviscon
– Maalox
– Mylanta
– Rolaids
H2 Histamine Antagonists
Axid AR ( Acid Reducer )
 Pepcid AC ( Acid Controller )
 Tagamet HB ( Heartburn )
 Zantac 75
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Proton Pump Inhibitors
Prevacid 24 HR
 Prilosec OTC
 Zegerid OTC
 Aciphex
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Odd Man Out
 Carafate
( Multi-Uses)
–Indigestion
–Ulcers (peptic and duodenal)
–Esophageal Varices
Present Problem
Vomiting
 Character: nature, quantity, duration,
frequency, ability to keep liquids down
 Relationship: meals,change in appetite, fever,
weight loss
Present Problem
Diarrhea
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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
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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
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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
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The Fs of Abdominal Distention
 Fat
 Fatal
Growth
 Feces
 Fibroid
 Flatus
 Fluid
Auscultation
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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
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Percussion
Palpation
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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
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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
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Liver Palpation
Palpation of the Spleen
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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
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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
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Common Abnormalities
Pancreatitis:
Sudden, excruciating
LUQ,epigastric pain,
may be umbilical. Pain
can refer to left shoulder
 Grey Turner:
ecchymosis over flanks
 Cullen sign; ecchymosis
around the umbilicus
 Associated findings:
vomiting, fever, shock
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Perforated Ulcer:
abrupt pain in RUQ,
may refer to both
shoulders
Associated findings:
free air and distension
with increased
resonance over the
liver. Tenderness in
epigastrium, rigid
abdomen
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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
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Intestinal Obstruction:
abrupt, severe,
spasmodic pain, may
refer to epigastrium,
umbilicus
 Associated Findings:
distention, vomiting,
localized tenderness,
visible peristalsis,
absent bowelsounds
or hyperactive
bowelsounds
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