The abdomen is commonly divided using a quadrant system.
R and L Upper quadrants
R and L Lower quadrants
Another system divides the abdomen into 9 areas:
R and L hypochondria
R and L lumbar
R and L inguinal
Epigastric
Umbilical
Suprapubic
Useful landmarks for the abdomen
the midclavicular line
Dermatomes
Epigastric area - T6
Umbilical area - T10
Suprapubic area - T12
Inspection and Draping:
Draping and Positioning - The patient should be positioned so that
the abdominal muscles are relaxed. It is important that the patient is
1) lying flat 2) have their arms at their sides 3) have a pillow. The
patient should be undraped so that the abdomen is visible from the nipples to at least the anterior superior iliac spines.
Inspection - The patient should be inspected for signs of liver
disease. Such as palmar erythema, Dupitran's contracture, jaundice etc.
One can look for bulging flanks from the foot of the bed.
Auscultation:
Bowel Sounds- Place the diaphragm of the stethoscope over the mid-abdomen. Normal bowel sounds occur every 5-10 seconds.
Each quadrant can be auscultated for bruits.
Percussion:
Abdomen - One can percuss the central abdomen: Hyper resonance may
indicate a bowel obstruction.
Percussion of the liver - percuss in the R mid-clavicular line. One
may proceed from "top down" or "bottom up". 10-12 cm
(male) or 8-10 (female) are the normal liver
sizes by percussion.
Percussion of the Spleen - Traube's Space boundaries: L anterior axilliary line, 6th rib, costal margin. This space should remain resonant
during full inspiration. Dullness on inspiration indicates possible
spleen enlargment.
Palpation
Light & deep palpation, AAA - Begin palpation away from any area of
pain (as identified from the history), and do the painful area last. Palpate
all 4 quadrants using both light and deep palpation. Using deep palpation, try
to identify any masses or areas of fullness. Abdominal aortic aneurysms
may present as a pulsatile mass in in the epigastric or periumbilical
regions. AAA palpation is not a requirement in year I ASCM.
Liver palpation - Begin in the R lower quadrant, slightly superior
to the inguinal ligament and proceed superiorly along the R mid-clavicular
line. Direct the patient's breathing, and try and palpate the liver edge
during the inspiratory phase.
Spleen palpation - Begin palpation in the R lower quadrant and
proceed diagonally towards Traube's space (as defined in the Percussion
section). Direct the patient's breathing, and try and palpate the spleen edge
during the inspiratory phase.
Kidney palpation - Usually, neither kidney is palpable in adults,
except in extremely thin patients.
