I.
Anatomy & Physiology of the Abdomen
1. Digestion – The mechanical and
A. Digestive System Structures & Functions chemical breakdown of food.
o Mechanical digestion:
1. Gastrointestinal (GI) Tract: Chewing, churning, and
segmentation.
Mouth – Initial site of digestion, o Chemical digestion:
mechanical and enzymatic Enzymatic breakdown of
breakdown. macromolecules.
2. Absorption – Transfer of
Esophagus – Transports food nutrients into the bloodstream or
from mouth to stomach. lymph.
o Occurs primarily in the
Stomach – Breaks down food small intestine.
with acid and enzymes. 3. Elimination – Removal of
indigestible substances and waste
Small Intestines – Absorption of products.
nutrients (duodenum, jejunum, o Involves the large
ileum). intestine, rectum, and
anus.
Large Intestines – Water
absorption and formation of Normal vs. Abnormal Findings in
feces. Abdominal Assessment
Rectum – Stores feces before 1. Inspection
elimination. Normal Abnormal
Aspect
Findings Findings
Anus – Site of defecation.
Distended,
2. Accessory Organs: Flat or scaphoid,
Contour slightly protuberant
Liver – Detoxifies blood,
rounded (fluid, gas,
produces bile, stores glycogen.
mass)
Gallbladder – Stores and
releases bile for fat digestion. Asymmetry
Symmetric (masses,
Symmetry
Pancreas – Produces digestive abdomen hernia,
enzymes and insulin. organomegaly)
Jaundice,
Smooth, cyanosis, pallor,
II. Process of Digestion and Elimination Skin
even-toned striae, rashes,
lesions
1. Ingestion – The act of taking in
food through the mouth.
Normal Visible dullness over (fluid, masses,
respiratory peristalsis liver/spleen organomegaly)
movements, (obstruction),
Movement
slight marked Enlarged (>12 cm
pulsations in pulsations Liver 6-12 cm in – hepatomegaly),
thin patients (aneurysm) Span adults decreased (<6 cm
– atrophy)
Everted
(ascites, Not Dullness in
Midline,
hernia), Spleen percussible Traube’s space
inverted, no
Umbilicus discoloration normally (splenomegaly)
signs of
(Cullen’s/Grey
inflammation Dullness over
Turner’s sign – Not
hemorrhage) suprapubic area
Bladder percussible
(urinary
unless full
retention, mass)
2. Auscultation
Normal Abnormal
Aspect 4. Palpation
Findings Findings
Normal Abnormal
Aspect
Absent Findings Findings
Present, (paralytic ileus),
Bowel normoactive hyperactive Tenderness
No
Sounds (5-30 sounds (diarrhea), (infection,
Light tenderness,
per minute) hypoactive inflammation),
Palpation soft
(obstruction) guarding
abdomen
(peritonitis)
Bruits (aortic
Vascular No bruits over Masses (tumors,
aneurysm, renal No
Sounds arteries cysts),
artery stenosis) palpable
Deep hepatomegaly,
masses,
Present over Palpation splenomegaly,
non-tender
Friction liver or spleen rigid abdomen
Absent organs
Rubs (infection, (peritonitis)
tumor)
Not Enlarged,
palpable or nodular
3. Percussion Liver
smooth, (cirrhosis,
Normal Abnormal firm metastases)
Aspect
Findings Findings
Not Palpable below
General Tympany Excessive Spleen palpable costal margin
Sound over tympany (gas), normally (splenomegaly)
intestines, excessive dullness
Not Enlarged, tender Appendix, right ovary &
Right Lower
Kidneys normally (infection, fallopian tube (females),
Quadrant
palpable hydronephrosis) right ureter, portions of
(RLQ)
intestines
Pain upon
release Left Lower Left ovary & fallopian tube
Rebound
No pain (peritoneal Quadrant (females), left ureter,
Tenderness
irritation, (LLQ) portions of intestines
appendicitis)
Additional regions:
IV. Abdominal Quadrants & Their Contents Umbilical: Area around the
Quadrant Organs Present navel.
Liver, gallbladder, part of Epigastric: Area between costal
Right Upper margins (above stomach).
pancreas, right kidney,
Quadrant
portions of small & large
(RUQ) Hypogastric/Suprapubic: Area
intestines
above the pubic bone.
Stomach, spleen, part of
Left Upper
pancreas, left kidney,
Quadrant
portions of small & large
(LUQ)
intestines
VII. Special Abdominal Tests
Tests for Ascites: Tests for Appendicitis:
o Shifting dullness test: o Rovsing’s sign: Pain in
Used to detect fluid the RLQ upon palpation
accumulation in the of the LLQ, indicating
peritoneal cavity by appendicitis.
percussing the abdomen
in different positions.
o Psoas sign: Pain elicited
by extending the patient’s
o Fluid wave test: right leg while they lie on
Assesses for ascites by their left side, suggesting
generating a fluid wave irritation of the psoas
through the abdomen and muscle due to
detecting movement on appendicitis.
the opposite side.
o Obturator sign: Pain in
the RLQ when flexing
and internally rotating the
right hip, indicating
possible appendicitis.
o Rebound tenderness
test: Pain upon sudden
release of deep palpation
in the RLQ, strongly
suggesting peritoneal
irritation, such as in
appendicitis.
Test for Cholecystitis:
o Murphy’s sign: Pain and
inspiratory arrest upon
deep palpation of the
RUQ during inhalation,
suggesting gallbladder
inflammation
(cholecystitis).
