Assessing the

Abdomen
 Functions of the Digestive System

• Ingestion
• Mechanical processing
• Chemical digestion
• Secretion
• Absorption
• Excretion
Histology of the GI Tract
Oral Cavity

Figure 22.8a
Oral Cavity
Salivary Glands
 The Pharynx

• Nasopharynx
• Oropharynx
• Laryngopharynx
The Esophagus
 The Stomach

• Site where food is churned into

chyme
• Protein digestion begins
The Stomach
The Stomach
Stomach
Gastric Pit and Gland
Ulcers in Stomach
 The Small Intestine
• Longest portion of the alimentary canal
• Site of most enzymatic digestion and
absorption
• Three subdivisions
– Duodenum, jejunum, and ileum
The Duodenum and Related
Organs

Figure 22.16
Small Intestine: Peyer’s Patches
 Gross
•Cecum Anatomy of Large Intestine
•Appendix
•Ascending
•Transverse
•Descending
•Sigmoid colon
•Rectum
•Anus
Figure 22.18a
Large Intestine
 Gross Anatomy of Large
Intestine
• Rectum – descends along the inferior half
of the sacrum
• Anal Canal – the last subdivision of the
large intestine
Gross Anatomy of Large Intestine

Figure 22.18b
Colon Cancer
The Pancreas

Figure 22.16
Pancreas
Ducts
Visceral Surface of the Liver

Figure 22.22
Microscopic Anatomy of Liver

Figure 22.23a, c, d
Microscopic Anatomy of Liver

Figure 22.23a, c, d
Liver Histology
Cirrhosis of the Liver
 The Gallbladder

• Stores and concentrates bile

• Expels bile into duodenum
– Bile emulsifies fats
The Gallbladder

Figure 22.16
Gallstones in a Gallbladder
Figure 22.16
Disorders of the Digestive System

• Intestinal obstruction
– Mechanical obstructions
• Adhesions, tumors, or foreign objects
– Nonmechanical obstruction
• Halt in peristalsis
– Trauma
– Intestines touched during surgery
Disorders of the Digestive System
• Inflammatory bowel disease
– Inflammation of intestinal wall
• Crohn’s disease
• Ulcerative colitis
• Viral hepatitis – jaundice and flu-like
symptoms
– Major types – A, B, C, and G
• Cystic Fibrosis and the Pancreas
 Definition of Terms
• Cholecystitis – inflammation of gallbladder.
• Cholelithiasis – calculi in the gallbladder.
• Choledocholithiasis – stones in CBD.
• Cholecystectomy – removal of gallbladder.
• Choledochotomy – opening of the CBD.
• Laser cholecystectomy – removal of
gallbladder using laser.
• Laparoscopic Choecystectomy – Removal of
the gallbladder using endoscopic procedure.
 Structure
• Stomach • Small intestines
• Large intestines • Liver
• Gall bladder
• Pancreas • Bladder

• Urinary tract
• Kidneys
 Function

What are the functions of…

• Stomach: churns food, intrinsic factor for
B12, hydrochloric acid begins digestion
• Small intestines: primary site for digestion
• Large intestines: absorbs sodium and
water
 Function
What are the functions of…
• Liver: metabolism; produces bile, clotting
factors; detoxifies drugs & alcohol;
converts glucose to glycogen; stores
vitamins
• Pancreas: produces insulin and glucagon,
pancreatic enzymes
 Function
What are the functions of…
• Gall bladder: stores and concentrates
bile
• Spleen: stores RBCs, produces RBCs
and macrophages
 Function
What are the functions of…
• Bladder: stores urine
• Kidneys: remove wastes, help control
B/P, produces erythropoietin
Relationship to Other Systems

• Integumentary • Respiratory
• HEENT • Musculoskeletal
• Lymphatic • Neurological
• Urinary
• Reproductive • Endocrine
• Cardiovascular
• Hematological
 The Digestive System in Later
Life
• Middle age – gallstones and ulcers
• Old age – activity of digestive organs
decline
– Fewer digestive juices and enzymes produced
– Absorption is less efficient
– Dehydration of fecal mass leads to
constipation
– Diverticulosis and cancer of digestive organs
 History
What can the history tell you about the
abdomen?
• Biographical data
• Current health status
• Past health history
• Family history
• Review of systems
• Psychosocial history
 Symptoms
What symptoms would signal an abdominal
problem?
• Pain
• Change in weight
• Change in bowel habits
• Indigestion
• Nausea and vomiting
 Pertinent History Findings

• No bowel movement for 4 days

• Dull, intermittent, lower abdominal
pain 2/10; walking makes it worse
• “Feels bloated”
 Pertinent History Findings

• Problem with constipation for past few

years; uses laxatives
• Cholecystectomy and appendectomy
• Diet: junk food, high fat
• No exercise
 Physical Assessment
• Anatomical landmarks: abdomen divided
into quadrant, or nine, or anatomical
structures
• Approach: inspection, auscultation,
percussion, palpation
• Position: supine
• Tools: stethoscope, ruler, pen, and tongue
blade for abdominal reflexes
• General survey and head-to-toe scan
 Inspection
Abdomen:
• Size, shape, symmetry
• Condition of skin: color, lesions, veins, hair
distribution, hernias
• Movements: respirations, pulsations, and
peristalsis
Umbilicus:
• Position, color, contour, and herniation
 Auscultation
Bowel sounds (all four quadrants):
• Note frequency and pitch
Friction rubs:
• Over inflamed organs or tumors
Scratch test:
• Locate lower edge of liver
 Percussion

Indirect (mediate): note tympany or

dullness
• All four quadrants
• Liver size
 Palpation
Light:
• Surface characteristics, tenderness,
guarding, turgor
Deep:
• Masses, organs
Other Assessment
Techniques
 1. Abdominal Reflexes

• Use a tongue depressor/cotton

buds
• Normally absent in elderly and
pregnant.
• Absent indicates Spinal nerve damage
 2. Ballotement
• For partially floating objects.
• Used in pregnant patients.
– Mass in abdomen if not pregnant.
 3. Kehr’s Sign
• Supine with right arm upward.
• No referred pain left shoulder.
– If present: Ectopic Pregnancy, renal
calculi, Spleenic injury
 4. Ballance Sign
• Peruss LUQ for dullness
• Normal : No dullness
• (+) : Peritoneal Irritation
Spleenic Injury
 5. Murphy’s Sign
• Palpate the Right midclavicular
line as pt take a deep breath.
• No pain
– (+) Cholecystitis
– GB CA
 6. Mc Burney’s Sign
• Palpate RLQ
• No pain

– (+) Pain: Appendiitis

 7. Obturator Muscle Test

• Supine and flex Right leg/knee

internally and eternally while
supporting the knee.
• No Pain
– (+) Pain : Ruptured AP
– Pelvic Abscess
 8. Rovsing’s Sign

• Place hand in LLQ and Press

deeply for 5 seconds.
• No pain
– (+) : AP, Peritoneal irritation
 9. Rebound Tenderness
• Place hand perpendicular to abdomen
• Press slowly and quickly
• No pain
– (+) Pain: AP
– Increasing pain : Peritoneal irritation