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Abdominal landmarks
xiphoid process
lower margin of costal
iliac antero-superior

Abdominal regions
four quadrants system
nine regions system

four quadrants system

one line
vertically from
the xiphoid to the
symphysis pubis,
the other line

Right upper quadrant


Right lower quadrant

ascending colon
small intestine

Left upper quadrant

liver (left lobe )

Left lower quadrant

sigmoid colon
descending colon
small intestine
left ovary and tube

Nine regions system

the abdomen is divided into nine
regions by four intersecting lines,
two horizontal linescostal arch
line and iliac spina line,
two vertical lines extending

right & left
right & left lumber
right & left iliac

Right hypochondrial
liver gallbladder
right kidney
hepatic flexure of colon
right lumber
ascending colon jejunum

liver (left lobe) pylorus
duodenum omentum
transverse colon
the head and body of pancreas


Left hypochondrial
spleen stomach
splenic flexure of colon
pancreas (tail part )
left kidney

left lumber

Seven quadrants system


the contents of inspection

1. abdominal contour
2. respiratory movement
3. abdominal veins

1. Abdominal contour
in healthy person abdomen is
usually flat from xiphoid to
symphysis pubis , we call
abdominal flat or even abdomen.
the umbilicus is located in the

Abdominal bulge
generalized abdominal bulge is
usually caused by ascites
some causes for ascites:
heart failure
cirrhosis of liver

When the patient is in supine

position, the flanks of patient is
bulging, the shape of abdomen
is like frog we call frog
abdomen. how to measure
abdominal circumference? with

the other causes of

abdominal bulge:
include the distention of the bowel
with trapped gas, such as intestinal
obstruction, massive tumor, such
as ovariogenic cystoma, factitious

both the patients with massive

ascites and obesity have
abdominal distention, how do
we distinguish from each other,
you can observe the
appearance of the umbilicus,

located abdominal fullness

upper abdominal fullness may
result from a mass in the upper
abdominal structures, such as liver
pancreas, stomach or transverse
colon. similarly fullness in the

the mass or tumor may be on the

abdominal wall or in the
abdominal cavity, how to
differentiate, you can ask patient
to make abdominal muscles
contract, if the tumor is more

Abdominal retraction
anterior abdominal wall is much lower
than the level from xiphoid to
symphysis pubis,

generalized abdominal retraction

we called scaphoid abdomen, mainly
seen in sever malnutritional status,

2. Respiratory movement
the manner of breathing: in men
and children, manner of breathing
is abdominal respiration. But in
women the manner of breathing is
thoracic respiration. In some

3. Abdominal veins
in healthy person abdominal
vein can not be seen or or can
be seen a little in thin person,
but not dilated, in patient with
obstruction of the portal

when you find distended veins on

the abdomen you should ascertain
the direction of flow. the normal
direction of flow is away from the
umbilicus , that is the upper
abdominal veins carry blood up

how to ascertain the

direction of blood flow
you can choice a segment
of vein, then the vein is
emptied between two
fingers to a distance
of a few centimeters,

4. Gastric or intestinal pattern

and peristalsis
in healthy person peristalsis is not
visible, but in patient with pyloric or
intestinal obstruction you can see
peristalsis, in pyloric obstruction on
epigastrium the peristalsis is from left

5. The skin of abdomen

(1) skin eruption
in some diseases especially
infectious disease such as
typhoid fever you can find
roseolas on the skin of

(2) Pigment
in normal condition, the pigment
of abdomen is more decreased
than exposed part of skin, in
patient with chronic
adrenocortical hypofunction also

There are two special sings of

discoloration on the abdominal
skin, One is Cullens sign: a bluish
discoloration around the
umbilicus, another is Turners
sign: a bluish discoloration of the

(3) Striae
silver striae distribute on the
lower quadrants of abdomen or
iliac regions, it is seen after a large
gain of weight or after pregnancy.
bluish striae (purple) distribute

(4) Scar
when you find a operation scar
on the patient abdomen, you
should ask some question about
the scar, when and why the
patient got the scar, the history

(5). Hernia
umbilical hernia may be seen in
belly or patient with a massive
incisional hernia operation scar
femoral hernia mainly seen in

(6) Hair distribution

in female the pubic hair is roughly
triangular with the base above the
symphysis. where as in male it is in
the shape of a diamond often with
hair continuing to the umbilicus,

(7). Epigastric pulsation

may be seen in the following
(1). thin person
(2). Right ventricular
hypertrophy COPD