2.

1c
History Taking of the Abdomen and Supplemental
Dr. Bates.

4 Aug
2014

Sanity
is a cozy lie Susan Sontag
chorva
chorva

Pasa

Paulo Coelho
ANATOMY OF ABDOMEN BY QUADRANTS
Right Upper Quadrant

Liver
o
o

soft consistency
lower edge is palpabale at the
costal margin
Gallbladder and duodenum are not palpable
Kidney
o
Lower pole is usually felt especially
in thin people with relaxed
abdominal muscles
Right Lower Quadrant
Appendix and Cecum not palpable
Ileocecal junction not palpable

Upper Midline
Xiphoid Process
Abdominal Aorta usually has
visible pulsations

Lower Midline
Bladder
o
Distended may be
palpated
o
300 ml of urine normal
o
400-500 full capacity of the
bladder
Sacral Promontory S1
Uterus and ovaries - women

Left Upper Quadrant

Spleen
o
Above the left kidney at the
midaxillary line
o
Tip of the spleen may be
palpable below the left
costal margin
Pancreas not palpable

Left Lower Quadrant

Portions of Transverse, Descending
Colon may be palpable
Sigmoid Colon

Discomfort
ABDOMINAL PAIN
o
o
o
o
o

VISCERAL PAIN
Distention of hollow abdominal organs biliary tree and
intestines
Solid organs such as liver painful when capsules are
stretched
May be difficult to localize
May be due to ischemia
Described as burning, gnawing, cramping, or aching

Examples:
o
RUQ pain Liver distention due to capsule irritation (alcoholic
hepatitis), biliary tree
o
Periumbilical pain - early acute appendicitis (changes to
parietal pain in the right lower quadrant peritoneal
inflammation)
o
Small intestine and proximal colon
o
Epigastric pain stomach, duodenum, pancreas
o
Suprapubic Pain rectum
o
Hypogastric colon, bladder, uterus

PARIETAL PAIN
o
o
o
o

Inflammation of the PARIETAL PERITONEUM

Steady, aching, and more severe pain
Localized
Aggravated by movement and coughing patients prefer
to lie still
REFERRED PAIN

o
o
o

Distant sites innervated at the same spinal level

Develops as more pain becomes intense
Usually localized but can be superficial or deep

Examples:
o
Duodenal/ Pancreatic Back
o
Biliary Tree Right shoulder or Right Posterior Chest
o
Pleuritic Pain or MI Epigastric Area
UPPER ABDOMINAL PAIN
ACUTE PAIN
Doubling Over with Cramping Renal Stone
Colicky Pain
Sudden knifelike Epigastric Gallstone Pancreatitis
Pain
Epigastric Pain
GERD, Gastritis
RUQ Pain
Cholecystitis
CHRONIC PAIN
Pain precipitated by exertion Angina from inferior wall CAD
and relieved by rest
Dyspepsia
Chronic or recurrent discomfort or
pain

TRANSCRIBED BY: WENG, DAWNN, JAZZY, RUSTY, FERY

Bloating
Belching
Functional
dyspepsia

or

nonulcer

Subjective negative feeling that is

NONPAINFUL
Inflammatory Bowel Disease
Aerophagia
3 month hx iof nonspecific upper
abdominal
discomfort
not
attributable
to
structural
abnormalities
May be caused by H. pylori

CHRONIC: Gastroesophageal Reflux Disease (GERD)

Mucosal damage on endoscopy

Associated with:
o
Heartburn rising retrosternal burning pain or
discomfort occurring weekly or more often
o
Acid Reflux
o
Regurgitation
o
Atypical Respiratory Symptoms cough, wheeze,
aspiration pneumonia
o
Pharyngeal Symptoms chronic sore throat,
hoarseness, laryngitis
o
Alarm symptoms dysphagia, odynophagia, GI
bleeding, weight loss, recurrent vomiting, anemia,
palpable mass, jaundice

Warrants endoscopy to check for Barretts

esophagus Squamocolumnar Junction is
displaced proximally and there is intestinal
metaplasia

LOWER ABDOMINAL PAIN

ACUTE PAIN
RLQ Pain periumbilical + Appendicitis
rigidity upon palpation
In
women,
PELVIC
INFLAMMATORY
DISEASE,
RUPTURED
OVARIAN
FOLLICLE,
ECTOPIC
PREGNANCY
Cramping Pain radiating to right Renal Stone
or left
LLQ Pain
Diverticulitis
Diffuse abdominal pain with Small or Large Bowel obstruction
absent bowel sounds and
firmness , guarding, and reboud
tenderness
CHRONIC PAIN
Change in bowel habits with Colon CA
mass lesion
Intermittent pain for 12 weeks of Irritable bowel SYNDROME
preceding 12 months with relief
of defecation, change in bowel
habits, stool consistency

Page 1 of 2

Abdomen

GI SYMPTOMS Associated with PAIN

NAUSEA feeling sick to the stomach

RETCHING involuntary spasm of the stomach, diaphragm, and
esophagus, precedes and culminates in vomiting
REGURGIATION raising esophageal or gastric contents without
nausea or retching
o
FECAL ODOR - suggests small bowel obstruction or
gastrocolic fistula
HEMATEMESIS coffee ground emesis or red blood emesis or
vomitus. May suggest esophageal varices or peptic ulcer disease

ANOREXIA loss of appetite

DYSPHAGIA difficulty swallowing from impaired passage of solid

foods or liquids from mouth to stomach. May suggest motility or
swallowing disorders
o
Lump in the throat is NOT true dysphagia
ODYNOPHAGIA pain upon swallowing

FLATUS excessive passage of gas (600ml/day)

DIARRHEA
increased water content of stool or stool volume or > 200g in 24
hours
o
ACUTE 2 weeks.

Caused by infection
o
CHRONIC 4 weeks or more

Crohns Disease or Ulcerative Colitis

TENESMUS constant urge to defecate, accompanied by pain,

cramping, and involuntary straining

HIGH VOLUME, frequent and watery small intestine

SMALL VOLUME with tenesmus rectal inflammation

CONSTIPATION
present for 12 weeks of the prior 6 months with at least 2 of
the following:
o
< 3 bowel movements per week
o
Iumpy or hard stools
o
Manual facilitation
o
More defecations with straining
Thin-pencil like stool Apple-Core lesion of sigmoid colon
(Colon CA)
OBSTIPATION no passage of either feces or gas. Suggests
intestinal obstruction
MELENA black tarry stools, and can be as little as 100 ml or
bleed. UPPER GI
HEMATOCHEZIA bright, maroon red, and can be >1000 ml or
blood from LOWER GI
Blood on tissue paper - hemorrhoids

JAUNDICE
yellowish discoloration of skin
Intrahepatic
o
Hepatocellular liver damage
o
Cholestatic impaired excretion due to damaged
hepatocytes or intrahepatic bile ducts (viral hepatitis,
cirrhosis, biliary cirrhosis, etc)
Extrahepatic obstruction of cystic and common bile
ducts(gallstones or pancreatic CA)
o
ACHOLIC STOOLS gray light-colored stools
Conjugated Bilirubin
o
Can be excreted in the urine
o
Yellowish brown or tea-colored
o
Unconjugated bilirubin is not soluble

TRANSCRIBED BY: WENG, DAWNN, JAZZY, RUSTY, FERY

Page 2 of 2