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ABDOMEN: Bates Chapter 11
RED and Blue highlighted areas are from Bates book
Structures by Quadrant
RUQ Sections LUQ
Liver Stomach
Gallbladder Spleen
Duodenum Epigastric Left lobe liver
Head of pancreas Body of pancreas
Right Kidney & Adrenal Left Kidney & adrenal
Hepatic flexure of colon Splenic flexure of colon
Part of ascending and Parts of transverse and
transverse colon descending colon
Umbilical
RLQ LLQ
Cecum Part of descending colon
Appendix Sigmoid Colon
Right Ovary/Fallopian Tube Left Ovary/Fallopian tube
Right Ureter Hypogastric Left Ureter
*McBurney’s point: 2” from Suprapubic
anterior superior spinous
process of ilium on a line drawn
from that point to the
umbilicus.
ABD H/HX: Common Concerning Symptoms
GI Disorders RED sx highlighted in ppt GU/Renal Disorders
Abd pain (Acute and Chronic) Suprapubic pain
Indigestion, N/V Difficulty urinating (dysuria)
Hematemesis Urinary urgency and Frequency
Anorexia, early satiety Hesitancy, stream (in males)
Difficulty swallowing (dysphagia) Polyuria, Nocturia
Pain with swallowing (odynophagia) Incontinence (stress, urgency,
Change in bowel function overflow, urge)
Diarrhea/Constipation Hematuria
Jaundice Flank pain
Upper GI Sx: Abd pain, heartburn, N/V Ureteral Colic
Lower GI Sx: Diarrhea, constipation, blood in *often accompanied by GI sx such as abd
stool, and change in bowel function. pain, N/V (from bates)
ABD H/Hx:
,2
Pain in ABD: Onset, duration (timing of pain)
o Intermittent/Persistent
o Acute vs Insidious onset
Location and movement of pain
Radiation of pain
Reproduceable?
Quality and Severity
Description – spasm, coliky, steady, dull, tearing, penetrating, sharp.
Recurrent Pain
Aggrivating/Relieving Factors.
*Ask patient to point to the location and describe sx in their own words*
Useful findings in Hx and PE
Although location of abd pain guides the initial evaluation, associated symptoms are
predictive of certain causes/sources of abd pain and can help narrow the DDx.
History
N/V Weigh gain/loss
Rectal bleeding Type of diet
Elimination o Pain in relation to meals
o Diarrhea/Constipation Change in appetite
o Change in color Urine/Stool Chewing swallowing problems
Hemorrhoids Heartburn
Voiding difficulty Age, Gender
Assoc sx: fever, cough, jaundice
Pain
Visceral pain:
Poorly localized – occurs often in the epigastrium, periumbilical and lower abdomen.
Occurs when hollow organs such as the intestines or biliary tree forcefully contract or are
distended/stretched. Solid organs such as the liver can cause pain when their capsules are
stretched.
May be difficult to localize.
Typically pain is palpable near midline and at levels according to the structure involved.
Ischemia also stimulates visceral pain fibers.
Visceral pain in RUQ suggests liver distention against its capsule from various causes of
hepatitis, including chronic alcoholic hepatitis.
Visceral periumbilical pain suggests early acute appendicitis from distention and inflamed
appendix. It gradually changes to parietal pain in RLQ from inflamed adjacent parietal
peritoneum.
, 3
Qualities of Visceral Pain:
Burning Sweating
Gnawing Pallor
Cramping N/V
Aching Restlessness
Severe pain
Types of Visceral Pain:
RUQ visceral pain or epigastric pain from inflamed biliary tree
Epigastric pain from stomach, duodenum, or pancreas
Periumbilical pain from small intestine, appendix or proximal colon.
Hypogastric pain (suprapubic pain) from the colon (colon pain may be more diffuse),
bladder, or uterus
Suprapubic or sacral pain from rectum
Parietal Pain (Somatic):
Well Localized, usually to a specific area. Pain is usually sharp.
Originates from inflammation of parietal peritoneum (called peritonitis)
Steady aching pain usually more severe than visceral and more precisely located over
the involved structure than visceral pain.
Aggravated by moving or coughing – patient may prefer to lay still.
In contrast to peritonitis, patient with colicky pain from renal stones will move around
and try to find a comfortable position.
Referred Pain:
Localized to an area remote from affected organ.
Felt in more distant sites which are innervated at approximately the same spinal level as
the disordered structure.
Referred pain often develops as the initial pain and becomes more intense.
Pain from duodenum or pancreas may be referred to the back
Pain from biliary tree may be referred to Right Scapula or right posterior thorax
Pain may also be referred to the abdomen from the chest, spine or pelvis
Pain from pleurisy or MI epigastric area
ABDOMEN: Bates Chapter 11
RED and Blue highlighted areas are from Bates book
Structures by Quadrant
RUQ Sections LUQ
Liver Stomach
Gallbladder Spleen
Duodenum Epigastric Left lobe liver
Head of pancreas Body of pancreas
Right Kidney & Adrenal Left Kidney & adrenal
Hepatic flexure of colon Splenic flexure of colon
Part of ascending and Parts of transverse and
transverse colon descending colon
Umbilical
RLQ LLQ
Cecum Part of descending colon
Appendix Sigmoid Colon
Right Ovary/Fallopian Tube Left Ovary/Fallopian tube
Right Ureter Hypogastric Left Ureter
*McBurney’s point: 2” from Suprapubic
anterior superior spinous
process of ilium on a line drawn
from that point to the
umbilicus.
ABD H/HX: Common Concerning Symptoms
GI Disorders RED sx highlighted in ppt GU/Renal Disorders
Abd pain (Acute and Chronic) Suprapubic pain
Indigestion, N/V Difficulty urinating (dysuria)
Hematemesis Urinary urgency and Frequency
Anorexia, early satiety Hesitancy, stream (in males)
Difficulty swallowing (dysphagia) Polyuria, Nocturia
Pain with swallowing (odynophagia) Incontinence (stress, urgency,
Change in bowel function overflow, urge)
Diarrhea/Constipation Hematuria
Jaundice Flank pain
Upper GI Sx: Abd pain, heartburn, N/V Ureteral Colic
Lower GI Sx: Diarrhea, constipation, blood in *often accompanied by GI sx such as abd
stool, and change in bowel function. pain, N/V (from bates)
ABD H/Hx:
,2
Pain in ABD: Onset, duration (timing of pain)
o Intermittent/Persistent
o Acute vs Insidious onset
Location and movement of pain
Radiation of pain
Reproduceable?
Quality and Severity
Description – spasm, coliky, steady, dull, tearing, penetrating, sharp.
Recurrent Pain
Aggrivating/Relieving Factors.
*Ask patient to point to the location and describe sx in their own words*
Useful findings in Hx and PE
Although location of abd pain guides the initial evaluation, associated symptoms are
predictive of certain causes/sources of abd pain and can help narrow the DDx.
History
N/V Weigh gain/loss
Rectal bleeding Type of diet
Elimination o Pain in relation to meals
o Diarrhea/Constipation Change in appetite
o Change in color Urine/Stool Chewing swallowing problems
Hemorrhoids Heartburn
Voiding difficulty Age, Gender
Assoc sx: fever, cough, jaundice
Pain
Visceral pain:
Poorly localized – occurs often in the epigastrium, periumbilical and lower abdomen.
Occurs when hollow organs such as the intestines or biliary tree forcefully contract or are
distended/stretched. Solid organs such as the liver can cause pain when their capsules are
stretched.
May be difficult to localize.
Typically pain is palpable near midline and at levels according to the structure involved.
Ischemia also stimulates visceral pain fibers.
Visceral pain in RUQ suggests liver distention against its capsule from various causes of
hepatitis, including chronic alcoholic hepatitis.
Visceral periumbilical pain suggests early acute appendicitis from distention and inflamed
appendix. It gradually changes to parietal pain in RLQ from inflamed adjacent parietal
peritoneum.
, 3
Qualities of Visceral Pain:
Burning Sweating
Gnawing Pallor
Cramping N/V
Aching Restlessness
Severe pain
Types of Visceral Pain:
RUQ visceral pain or epigastric pain from inflamed biliary tree
Epigastric pain from stomach, duodenum, or pancreas
Periumbilical pain from small intestine, appendix or proximal colon.
Hypogastric pain (suprapubic pain) from the colon (colon pain may be more diffuse),
bladder, or uterus
Suprapubic or sacral pain from rectum
Parietal Pain (Somatic):
Well Localized, usually to a specific area. Pain is usually sharp.
Originates from inflammation of parietal peritoneum (called peritonitis)
Steady aching pain usually more severe than visceral and more precisely located over
the involved structure than visceral pain.
Aggravated by moving or coughing – patient may prefer to lay still.
In contrast to peritonitis, patient with colicky pain from renal stones will move around
and try to find a comfortable position.
Referred Pain:
Localized to an area remote from affected organ.
Felt in more distant sites which are innervated at approximately the same spinal level as
the disordered structure.
Referred pain often develops as the initial pain and becomes more intense.
Pain from duodenum or pancreas may be referred to the back
Pain from biliary tree may be referred to Right Scapula or right posterior thorax
Pain may also be referred to the abdomen from the chest, spine or pelvis
Pain from pleurisy or MI epigastric area
