Structure and Function

The abdomen is bordered superiorly by the costal

margins, inferiorly by the symphysis pubis and inguinal
canals, and laterally by the flanks.

Abdominal Quadrants

The abdomen can be described as having four quadrants: the

right upper quadrant (RUQ), right lower quadrant (RLQ), left
lower quadrant (LLQ), and left upper quadrant (LUQ)

Abdominal regions

Abdominal Wall Muscles

The abdominal contents are enclosed externally by the

abdominal wall musculature, which includes three layers of
muscle extending from the back, around the flanks, to the
Abdominal quadrants
front. The outermost layer is the external abdominal oblique,
 The quadrants are determined by an imaginary the middle layer is the internal abdominal oblique, and the
vertical line (midline) extending from the tip of the innermost layer is the transverse abdominis
sternum (xiphoid) through the umbilicus to the
symphysis pubis
 This line is bisected perpendicularly by the lateral
line, which runs through the umbilicus across the
abdomen

Abdominal Regions

Another method divides the abdomen into nine regions

 Three of these regions are still commonly used to

describe abdominal findings: epigastric, umbilical,
and hypogastric or suprapubic

Abdominal wall muscles

 Connective tissue from these muscles extends

forward to encase a vertical muscle of the anterior
abdominal wall called the rectus abdominis
- The fibers and connective tissue extensions of
these muscles (aponeuroses) diverge in a
 characteristic plywood-like pattern (several thin
layers arranged at right angles to each other),
which provides strength to the abdominal wall
- The joining of these muscle fibers and
aponeuroses at the midline of the abdomen forms
a white line called the linea alba, which extends
vertically from the xiphoid process of the
sternum to the symphysis pubis
 The abdominal wall muscles protect the internal
organs and allow normal compression during
functional activities such as coughing, sneezing,
urination, defecation, and childbirth

Internal Anatomy Abdominal Viscera

Peritoneum Solid Viscera

 a thin, shiny, serous membrane that lines the Liver

abdominal cavity (parietal peritoneum) and also
 it is the largest solid organ in the body
provides a protective covering for most of the
 it is located below the diaphragm in the RUQ of the
internal abdominal organs (visceral peritoneum)
abdomen
Abdominal Viscera  it is composed of four lobes that fill most of the RUQ
and extend to the left midclavicular line
 within the abdominal cavity are structures of several
 In many people, the liver extends just below the right
different body systems: gastrointestinal, reproductive
costal margin, where it may be palpated
(female), lymphatic, and urinary
- If palpable, the liver has a soft consistency
Two Types  The liver functions as an accessory digestive organ
and has a variety of metabolic and regulatory
Solid Viscera
functions as well, including glucose storage,
 are those organs that maintain their shape formation of blood plasma proteins and clotting
consistently: liver, pancreas, spleen, adrenal glands, factors, urea synthesis, cholesterol production, bile
kidneys, ovaries, and uterus formation, destruction of red blood cells, storage of
iron and vitamins, and detoxification
Hollow Viscera
Pancreas
 consist of structures that change shape depending on
their contents. These include the stomach,  located mostly behind the stomach deep in the upper
gallbladder, small intestine, colon, and bladder abdomen, is normally not palpable
 It is a long gland extending across the abdomen from
the RUQ to the LUQ
 Two functions:
- it is an endocrine gland and an accessory organ
of digestion
Spleen - Therefore, in some thin clients, the bottom
portion of the right kidney may be palpated
 it is approximately 7 cm wide and is located above
anteriorly
the left kidney just below the diaphragm at the level
 Primary Function:
of the ninth, tenth, and eleventh ribs
- filtration and elimination of metabolic waste
 It is posterior to the left mid-axillary line and
products
posterior and lateral to the stomach
- also play a role in blood pressure control and
 This soft, flat structure is normally not palpable
maintenance of water, salt, and electrolyte
- In some healthy clients, the lower tip can be felt
balances
below the left costal margin
- they function as endocrine glands by secreting
 Functions: The spleen functions primarily to filter the
hormones
blood of cellular debris, to digest microorganisms,
and to return the breakdown products to the liver Uterus

Kidneys  The pregnant uterus may be palpated above the level

of the symphysis pubis in the midline.
 located high and deep under the diaphragm
 These glandular, bean-shaped organs measuring Ovaries

approximately 10 × 5 × 2.5 cm are considered

 located in the RLQ and LLQ, and are Normally
posterior organs and approximate with the level of
palpated only during a bimanual examination of the
the T12 to L3 vertebrae
internal genitalia
 The tops of both kidneys are protected by the
posterior rib cage Hollow Viscera
 Kidney tenderness is best assessed at the
Stomach
costovertebral angle
 The abdominal cavity begins with the stomach
 It is a distensible, flask-like organ located in the LUQ
just below the diaphragm and between the liver and
spleen
 The stomach is not usually palpable
 Main Function: is to store, churn, and digest food

Gallbladder

 a muscular sac approximately 10 cm long

 Main Function: concentrate and store the bile needed
to digest fat
Position of
 It is located near the posterior surface of the liver
the kidneys
lateral to the mid-clavicular line
 It is not normally palpated because it is difficult to

 Right Kidney: it is positioned slightly lower because distinguish between the gallbladder and the liver

of the position of the liver

Small Intestine
  It is actually the longest portion of the digestive tract
- approximately 7.0 m long but is named for its
Sigmoid colon
small diameter approximately 2.5 cm
 Two major functions: digestion and absorption of  sigmoid colon is often felt as a firm structure on
nutrients through millions of mucosal projections palpation, whereas the cecum and ascending colon
lining its walls may feel softer. The transverse and descending colon

 The small intestine, which lies coiled in all four may also be felt on palpation

quadrants of the abdomen, is not normally palpated

Urinary Bladder

Colon (Large Intestine)

 it is a distensible muscular sac located behind the

 it has a wider diameter than the small intestine pubic bone in the midline of the abdomen

- approximately 6.0 cm and is approximately 1.4  Function: temporary receptacle for urine

m long  A bladder filled with urine may be palpated in the

 It originates in the RLQ, where it attaches to the abdomen above the symphysis pubis
small intestine at the ileocecal valve
 Primary Function:
- To secrete large amounts of alkaline mucus to Vascular Structures
lubricate the intestine and neutralize acids
The abdominal organs are supplied with arterial blood by the
formed by the intestinal bacteria
abdominal aorta and its major branches
- Water is also absorbed through the large
intestine, leaving waste products to be eliminated
in stool

Major Sections

Ascending colon

 extends up along the right side of the abdomen

 At the junction of the liver in the RUQ, it flexes at a
right angle and becomes the transverse colon

Transverse colon

 it runs across the upper abdomen

 In the LUQ near the spleen, the colon forms another
right angle then extends downward along the left side
of the abdomen as the descending colon

Descending Colon Abdominal

and vascular structures (aorta and iliac artery and vein).

 At this point, it curves in toward the midline to form

Pulsations of the aorta are frequently visible and palpable
the sigmoid colon in the LLQ
midline in the upper abdomen. The aorta branches into the
right and left iliac arteries just below the umbilicus. Pulsations
of the right and left iliac arteries may be felt in the RLQ and
LLQ

Different Types of Abdominal Pain

Visceral Pain

 Hollow Abdominal Organs: occurs when hollow

abdominal organs such as the intestines become
distended or contract forcefully
 Solid Abdominal Organs: when the capsules of solid
organs such as the live and spleen are stretched
 Characteristics:
- poorly defined or localized and intermittently
timed
- dull, aching, burning, cramping, or colicky

Parietal Pain

 Occurs when the parietal peritoneum becomes

inflamed, as in appendicitis or peritonitis
 Characteristics:
- tends to localize more to the source
- severe and steady pain

Referred Pain

 Occurs at distant sites that are innervated at

approximately the same levels as the disrupted
abdominal organ
 Characteristics:
- Travels or refers from the primary site and
becomes highly localized at the distant site

Common Clinical Patterns and Referents of Pain Character of Abdominal Pain and
Implication

Dull, Aching

Appendicitis Irritable bowel syndrome

Acute hepatitis Hepatocellular cancer

Biliary colic Pancreatitis

 Cholecystitis Pancreatic cancer Splenic rupture Ureteral colic

Cystitis Perforated gastric or Renal colic Vascular liver

duodenal ulcer tumor
Dyspepsia Peritonitis

Variable
Glomerulonephritis Peptic ulcer disease
Stomach Cancer
Incarcerated or strangulated Prostatitis
hernia

Burning, Gnawing

Dyspepsia Appendicitis

Peptic ulcer disease Colitis

Cramping (“crampy”) Diverticulitis

Acute mechanical Gastroesophageal reflux

obstruction disease (GERD)

Pressure

Benign prostatic hypertrophy

Prostate cancer
Prostatitis
Urinary retention

Colicky

Colon Cancer

Sharp, Knifelike

Splenic abscess Renal tumor