( Y D O X D W L R Q & R S \
Structure and Function
The abdomen is bordered superiorly by the costal margins,inferiorly by the symphysis pubis and inguinal canals, and lat-erally by the ﬂanks (Fig. 18-1). To perform an adequate as-sessment of the abdomen, the nurse needs to understand theanatomic divisions known as the abdominal quadrants, theabdominal wall muscles, and the internal anatomy of the ab-dominal cavity.
The abdomen is divided into four quadrants for purposesof physical examination. These are termed the right upperquadrant (RUQ), right lower quadrant (RLQ), left lowerquadrant (LLQ), and left upper quadrant (LUQ). The quad-rants are determined by an imaginary vertical line (mid-line) extending from the tip of the sternum (xiphoid),through the umbilicus to the symphysis pubis. This line isbisected perpendicularly by the lateral line, which runsthrough the umbilicus across the abdomen. Familiarization with the organs and structures in each quadrant is essen-tial to accurate data collection, interpretation, and do-cumentation of findings (Display 18-1). Another, oldermethod divides the abdomen into nine regions. Three of these regions are still commonly used to describe abdom-inal findings—epigastric, umbilical, and hypogastric orsuprapubic.
Abdominal Wall Muscles
The abdominal contents are enclosed externally by the ab-dominal wall musculature, which includes three layers of muscle extending from the back, around the ﬂanks, to thefront. The outermost layer is the external abdominal oblique;the middle layer is the internal abdominal oblique; and theinnermost layer is the transverse abdominis. Connective tis-sue from these muscles extends forward to encase a verticalmuscle of the anterior abdominal wall called the rectusabdominis. The ﬁbers and connective tissue extensionsof these muscles (aponeuroses) diverge in a characteristicplywood-like pattern (several thin layers arranged at rightangles to each other), which provides strength to the ab-dominal wall. The joining of these muscle ﬁbers andaponeuroses at the midline of the abdomen forms a whiteline called the linea alba, which extends vertically from thexiphoid process of the sternum to the symphysis pubis(Fig. 18-2). The abdominal wall muscles protect the inter-nal organs and allow normal compression during functionalactivities such as coughing, sneezing, urination, defecation,and childbirth.
A thin, shiny, serous membrane called the peritoneumlines the abdominal cavity (parietal peritoneum) and alsoprovides a protective covering for most of the internalabdominal organs (visceral peritoneum). Within the ab-dominal cavity are structures of several different body systems—gastrointestinal, reproductive (female), lymphatic,and urinary. These structures are typically referred to as theabdominal viscera and can be divided into two types—solid viscera and hollow viscera. Solid viscera are those organsthat maintain their shape consistently—the liver, pancreas,spleen, adrenal glands, kidneys, ovaries, and uterus. Thehollow viscera consist of structures that change shape de-pending on their contents. These include the stomach, gall-bladder, small intestine, colon, and bladder. Palpation of theabdominal viscera depends on location, structural consis-tency, and size.
The liver is the largest solid organ in the body. It is lo-cated below the diaphragm in the RUQ of the abdomen.It is composed of four lobes that fill most of the RUQ andextend to the left midclavicular line. In many people, theliver extends just below the right costal margin, where itmay be palpated. If palpable, the liver has a soft consis-tency. The liver functions as an accessory digestive organand has a variety of metabolic and regulatory functions as well (Fig. 18-3).The pancreas, located mostly behind the stomach, deepin the upper abdomen, is normally not palpable. It is a longgland, extending across the abdomen from the RUQ to theLUQ. The pancreas has two functions. It is an accessory organ of digestion and an endocrine gland.The spleen is approximately 7 cm wide and is locatedabove the left kidney, just below the diaphragm at the levelof the ninth, tenth, and eleventh ribs. It is posterior to theleft midaxillary line and posterior and lateral to the stomach.