Anatomy of Abdomen

Anatomy of Abdomen  Abdominal cavity spans from the diaphragm to the pubis o Organs inside called abdominal viscera; two types of viscera  Solid viscera: organs that maintain their shape consistently; ex. uterus, ovaries  The liver is the largest internal organ and also the largest gland in the human body. It performs a wide range of functions including detoxification, protein synthesis, and production of biochemicals necessary for digestion  The spleen is similar in structure to a large lymph node and functions as part of the immune system by attacking foreign antibodies and diseases. It also filters old and dying red blood cells, holds a reserve of blood, and recycles iron  The pancreas produces important hormones including insulin, glucagon, somatostatin, and pancreatic polypeptides which circulate in the blood. In addition, the pancreas secretes pancreatic juice containing digestive enzymes that assist in the breakdown and absorption of nutrients in the small intestine  The kidneys function as an essential part of the urinary system by sifting out waste and extra water from the blood. These are excreted by the kidneys as urine, which flows through the ureter and empties into the urinary bladder  Hallow viscera: organs whose shape depends on their content  Inside the stomach, a rounded and highly elastic organ, food is churned by muscular contractions. Digestive enzymes and hydrochloric acid secreted by the stomach assist in the breakdown of food  The gallbladder stores and concentrates bile produced by the liver. When food enters the digestive tract, the gallbladder releases bile into the small intestine where it aids in the digestion of lipids. The removal of the gallbladder, in most cases, has little to no effect on the body is functioning  The majority of digestion and absorption occurs in the small intestine, where bile and pancreatic juices work to break down food. The small intestine is divided into the duodenum, jejunum, and ilium  The colon (large intestine) has four parts: ascending, transverse, descending, and sigmoid. Throughout the colon, water, salt, and some nutrients are removed from digested food. This results in the formation of stool, which is move through the colon by strong muscle contractions  The bladder is an elastic, muscular sac that stores urine excreted by the kidneys. When the muscles of the bladder contract, urine is passed into the urethra before exiting the body Both solid and hollow viscera rely heavily on oxygenated blood supplied by the abdominal aorta, which descends through the abdominal cavity, just left of the midline along the posterior abdominal wall  They abdominal quadrants are formed by a horizontal line and a vertical line across the umbilicus. Dividing the abdomen into quadrants helps visualize and describe the location of internal structures o The right lower quadrant (RLQ) contains the appendix, right ureter, and part of the ascending colon. In females, it contains the right ovary and fallopian tube. In males it contains the right spermatic cord o The right upper quadrant (RUQ) contains the liver, gallbladder, duodenum, head of pancreas, right kidney, and sections of the large intestine including the ascending and transverse colon o The left upper quadrant (LUQ) contains the stomach, spleen, left lobe of the liver, body of the pancreas, left kidney, and sections of the large intestine including the transverse and descending colon. o The left lower quadrant (LLQ) contains the upper ureter, sigmoid colon, and part of the descending colon. In females, it contains the left ovary and Fallopian tubes. In males, it contains the left spermatic cord Abdominal Exam  Before beginning an abdominal examination, certain practices help ensure your patient’s comfort and safety: o Make sure that your patient has an empty bladder o Ask your patient to assume a comfortable, supine position o Ask your patient to point to any painful areas. During the palpable portion of the examination, these areas should be examined last o Conducted the abdominal examination while standing at your patient’s right hand side o Warm your stethoscope before auscultation, avoid sudden movements, and use conversation to help put your patient at ease o Visualize the organs in each region you are examining o Monitor your patience facial expression for any signs of discomfort  Physical examination o Abdominal examination was performed in order of inspection, auscultation, percussion, palpation. Failure to adhere to this order may alter findings  First inspect the abdomen to gather visual data on patient's health. Skin gives signs of pathology including discoloration, rashes, and dilated veins. Contour of abdomen is evaluated for distension, asymmetry, abdominal pulsations, and protuberances. Ask about any scars to gather data on injuries or surgeries  After inspection, auscultate the abdomen to assess the quality and frequency of sound made by digestive processes and air moving through the bowels. There are a wide range of bowel sounds including gurgling, cascading, rushing, and tinkling. Since bowel sounds are often high-pitched, the diaphragm of the stethoscope is used. You should always listen to all quadrants clockwise: RLQ -> RUQ -> LUQ -> LLQ o Three types of bowel sounds: normoactive, hyperactive, hypoactive  Normoactive bowel sounds occur regularly every 5 to 15 seconds. They encompass a range of sounds including gurgling and cascading, indicating a healthy level of intestinal activity  Hyperactive bowel sounds occur with increased frequency And are often louder than normoactive bowel sounds. They indicate increased intestinal activity  Hypoactive bowel sounds are quiet and infrequent signs that indicate reduced intestinal activity. Absent bowel sounds, the most severe form of hypoactivity, can only be determined after 3 to 5 minutes of continuous listening in each quadrant We percuss the abdomen to assess organs and screen for masses. Abdominal percussion produces two types of sound: tympanic and dull; When percussing, tympany should predominate unless over liver, spleen, distended bladder, fluid, or mass. A third percussion sound, resonance , is normally heard over the lungs; scattered dullness in lower quadrats indicate fecal matter in colon  Tympanic sounds are heard over areas containing air, such as normal intestines.  Dull sounds are heard over areas that are distended, fluidfilled, or dense, such as the liver After percussion, palpate the abdomen to assess organs, find masses, and locate any tender areas. Palpation must be performed last because it can shift organs, masses, or may affect the digestive process, which would alter findings. Two types of population: light (1cm) and deep (5-8cm)   