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The Abdomen

The Abdomen. 1. Anatomy & Physiology 2. History 3. Examination & Findings 4. Common Abnormalities. The Abdomen. Anatomy and Physiology. Anatomy and Physiology. The Gastrointestinal tract Mouth  Esophagus  Stomach  Small Intestines : Duodenum  Jejunum  Ileum

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The Abdomen

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  1. The Abdomen 1. Anatomy & Physiology 2. History 3. Examination & Findings 4. Common Abnormalities

  2. The Abdomen Anatomy and Physiology

  3. Anatomy and Physiology The Gastrointestinal tract Mouth Esophagus Stomach  SmallIntestines: Duodenum  Jejunum  Ileum Large Intestines: Cecum  Colon  Sigmoid Colon  Rectum  Anus

  4. Function & Control • Ingest and Digest Food • Absorb Nutrients, Electrolytes and Water • Excrete Waste products • Controlled by Autonomic Nervous System

  5. The Liver • Location: right upper quadrant • Weight: 3 lbs • Composition: four lobes containing lobules, the functional units of the liver • Blood supply: hepatic artery brings blood from the aorta directly to the liver. • The portal vein brings blood from the digestive tract and the spleen to the liver • Three hepatic veins empty blood from the liver into the inferior vena cava

  6. Liver Function • Metabolism of carbohydrates, fats and protein • Glucose is converted and stored as Glycogen • Amino acids are broken down and their waste products converted to urea for excretion • Amino acids can be converted to glucose: gluconeogenesis • Fats arriving as fatty acids are oxidized into carbon components

  7. Liver Function • Cholesterol is used to form bile salts • Storage of vitamins and iron • Detoxification, production of antibodies, conjugation & excretion of steroid hormones • Production of prothrombin, fibrinogen and other substances for coagulation • The liver is responsible for the majority of the proteins circulating in the plasma

  8. The Gallbladder • Location: under the inferior surface of the liver in the right upper quadrant • Function: concentration and storage of bile from the liver • Cholecystokinin: a hormone produced by the duodenum: causes bile to be released in the common bile duct and into the duodenum • Bile maintains the alkaline pH of the small intestines so fats can be emulsified in order to be absorbed

  9. The Pancreas • Location: behind and beneath the stomach, epigastric region and left upper quadrant • Exocrine function: production of digestive juices containing inactive enzymes for the breakdown of proteins, fats and carbohydrates • The pancreatic duct empties into the duodenum, alongside the common bile duct • The digestive enzymes become activated in the duodenum

  10. The Pancreas • Endocrine function: the production of the hormones insulin and glucagon • Produced by the islet cells • Secreted directly into the blood, to regulate the body’s level of glucose.

  11. The Spleen • Location: left upper quadrant, above the left kidney, below the diaphragm • Composition: lymphoid tissue • Function: filter blood as part of the reticuloendothelial system (RES): defense against infection and disposal of products of the breakdown of cells • Manufactures lymphocytes and monocytes • Storage area for blood

  12. Kidneys Posterior View

  13. The Kidneys, Ureters, and Bladder • Function: reabsorption of electrolytes, small proteins and water, The kidneys control the water and electrolyte balances of the body • Elimination of waste products in urine • Endocrine Gland: produces renin, important in the control of aldosterone secretion • Erythropoietin production:regulates the red blood cell production • Production of the active form of vitamin D

  14. The Kidneys, Ureters, and Bladder • Urine passes into the renal pelvis via the collecting tubules and then into the ureter • Peristaltic waves move the urine into a reservoir: the bladder • The Bladder has a capacity of 400-500 ml • Urine then is eliminated from the body via the urethra

  15. The Abdomen History

  16. Present Problem • Abdominal Pain: Onset and Duration Character Location • Associated symptoms: nausea,vomiting, diarrhea, constipation, flatus, belching, jaundice • Relationship: body position, inspiration, food intake, menstrual cycle, urination, defecation, time of day

  17. Referred Pain

  18. Present Problem Indigestion: GERD • Character: fullness, heartburn, discomfort, belching, loss of appetite • Association: with food intake, time, amount, type of food intake • Onset of symptoms: sudden, gradual, day or night • Symptom relieve: rest, antacids • Medication: OTC and prescribed • Nausea: stimuli, with or without vomiting

  19. GI Tract

  20. Types of Antacids to Look UP • OTC (Old Remedy- Tablespoon of Baking Soda) • Alka-Seltzer • Tums • Milk of Magnesia • Pepto-Bismol • Gaviscon • Maalox • Mylanta • Rolaids

  21. H2 Histamine Antagonists • Axid AR ( Acid Reducer ) • Pepcid AC ( Acid Controller ) • Tagamet HB ( Heartburn ) • Zantac 75

  22. Proton Pump Inhibitors • Prevacid 24 HR • Prilosec OTC • Zegerid OTC • Aciphex

  23. Odd Man Out • Carafate ( Multi-Uses) • Indigestion • Ulcers (peptic and duodenal) • Esophageal Varices

  24. Present Problem Vomiting • Character: nature, quantity, duration, frequency, ability to keep liquids down • Relationship: meals,change in appetite, fever, weight loss

  25. Present Problem Diarrhea • Character: copious, watery, explosive, color, presence of blood, number of times a day • Associated symptoms: chills, fever, thirst, weight loss, pain and or cramping, incontinence • Relationship: timing, nature of food intake, stress • Travel History • Medication: OTC or prescribed, laxatives, stool softeners, antidiarrheals

  26. Present Problem Constipation • Character: presence of blood: black, bright, tarry. Alternating with diarrhea, with or without abdominal discomfort • Pattern: last BM, pain with passage of BM, changes in pattern • Diet: recent changes in diet • Medication: OTC and prescribed, laxatives, stool softeners, diuretics, iron

  27. Present Problem Jaundice • Onset and Duration • Color of stool and urine • Associated with abdominal pain, fever, chills • Exposure to Hepatitis • Medications: high doses of acetaminophen

  28. Past Medical Problem • Gastrointestinal Disorders: Peptic Ulcer Disease, GERD, inflammatory Bowel Disease, intestinal Obstruction, Pancreatitis • Hepatitis or Cirrhosis of the Liver • Surgery: abdominal or urinary tract • Major Illness: Cancer, arthritis( steroids/aspirin use), Kidney Disease, Cardiac Disease • Blood Transfusions • Hepatitis Vaccine

  29. Family History • Gallbladder Disease • Kidney Disease: kidney stones, polycystic disease • Malabsorption syndrome: cystic fibrosis, celiac disease

  30. Personal and Social History • Nutrition: preferences and dislikes, ethnic foods, religious food restrictions, food intolerance's, weight gain or loss • Alcohol Intake and use of illegal drugs • Recent physical or psychological changes • Exposure to infectious disease: flu, travel history • Trauma

  31. The Abdomen Examination and Findings

  32. Epigastric Region 1.Pyloric end of the stomach Duodenum Pancreas Portion of the liver

  33. Umbilical Region 2.Omentum Mesentery Transverse Colon Lower part of the Duodenum Jejenum and Ileum

  34. Hypogastric Region 3.Ileum Bladder Uterus in pregnancy

  35. Right Hypochondriac Region 4.Right lobe of the liver Gallbladder Portion of the Duodenum Hepatic Flexure of the Colon Portion of the right Kidney Suprarenal Gland

  36. Left Hypochondric Region 5.Stomach Spleen Tail of the Pancreas Splenic Flexure of the Colon Upper pole of the left Kidney Suprarenal Gland

  37. Right Lumbar Region 6.Ascending Colon Lower half of the right Kidney Portion of the Duodenum and Jejunum

  38. Left Lumbar Region 7.Descending Colon Lower half of the left Kidney Portion of the Duodenum and Jejunum

  39. Right Inguinal Region 8.Cecum Appendix Lower end of Ileum Right Ureter Right Spermatic Cord Right Ovary

  40. Left Inguinal Region 9.Sigmoid Colon Left Ureter Left Spermatic Cord Left Ovary

  41. Inspection • Inspect the abdomen for contour, symmetry and surface motion • Note location and contour of umbilicus • Distention: above umbilicus: gastric dilation, carcinoma, pancreatic cyst Below umbilicus: ovarian tumor, pregnancy, uterine fibroids, distended bladder • Ask patient to take a deep breath on hold it

  42. The Fs of Abdominal Distention • Fat • Fatal Growth • Feces • Fibroid • Flatus • Fluid

  43. Auscultation • Listen for bowelsounds: note frequency and character • Borborygmi: stomach growling • High-pitched tinkling sounds: suggestive of intestinal fluid and air under pressure, in early obstruction • Decreased Bowelsounds: paralytic ileus and with peritonitis • Vascular Sounds: listen with the bell for bruits in the aortic, renal ,iliac and femoral arteries

  44. Auscultation

  45. Auscultation Vascular Sounds

  46. Percusion • Assessment of size and density of abdominal organs • Listen for tympany ( predominant, produced by air in stomach and intestines) and dullness ( over solid organs and masses) • Start with an area of tympany and proceed to an area of dullness

  47. Percussion

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