DIVISION TOPOGRAPHIC:

Draw 2 horizontal lines and vertical 2: the upper horizontal line passing through
the lower limit of the rib flange; the horizontal bottom, by both iliac crests tubers;
the vertical lines are symmetrical . And continue to the clavicular medium.
Delimiting 9 abdominal regions:

TOPOGRAPHIC DIVISION OF THE ABDOMEN

1. RIGHT UPPER QUADRANT: liver (LD) colon (AD) kidney right renal
pelvis and ureter initial. Gadrenal right
2. EPIGASTRIUM:stomach (lower curvature, part of the body, antrum and
pyloric duct), duodenum, liver, gallbladder, pancreas (head), aorta, VCl,
celiac plexus.
3. upper left'quadrant: stomach, (background and part of the body), spleen,
colon, (Al), pncreas tail), left kidney, renal pelvis and ureter, g. left
adrenal
4. Rieht FLANK: ascending colon, kidney and ureter.
5. UMBILICAL: stomach, duodenum, jejunum, transverse colon, pancreas,
ureters, mesentery, aorta and inferior vena cava
6. Left FlANK: descending colon, ureter.
7. Rieht Iliac Fossa: cecum,appendix,ileum
8. HYPOGASTRIUM: small intestine, sigmoid colon, bladder and ureters.
9. Left ILIAC FOSSA: sigmoid colon.
lnspection
The inspection has began with the patient standing,is observed on the front
profile and behind; then continues in supine, whith arms to the sides of the
body, legs extended, head "slightly elevated. Direct and tangential light.
This technique allows to observe:
a) morphology: shape, size and symmetry. I
b) State of the wall: deformations global and partial, as either depressions
or prominences.

c) surface condition: there are conditions of the skin, hair system and its
implementation, the characteristics of the navel and the. presence of
scars.
d) Movements: may be respiratory, circulatory, nervous, digestive or fetal.
It have different depends on
Age

Weight for height

Constitution of the body (athlete or sedentary)
Or by alterations such as:
(a) Tumors
(b) Ascites
(c) Bloating
(d) Masses

NORMAL ABDOMEN:
lt is rounded or flat
lt is symmetrically on each side of the midline
ln thin: excavated Abdomen (escafoide or concave)
Obese: bulky Abdomen: globulous or prominent

There are 3 different pathological types of abdomen:

GLOBOSE: Increase intra-abdominal. Protrusion of abdominal scar

Umbilical hernias can be substation in: pregnancy, lntra-abdominal
tumors, The ovaria cysts, Ascites

Frog belly: Front side of the belly is lost muscle tone. Are presented in:
Elderly
Obese
Pregnancy to term (multiparous)

ABDOMEN PANNING: Loss of cellular tissue and muscle mass, The

bony protrusions are emphasized, The skin is dry and smooth, Skin folds
are emphasized, Retracted urn bilical scar

SCARS
KOCHER INCISION: Below the right costal edge
PFANNESTIEL INCISION: Convex above the pubic symphysis
ISUPRAUMBILICAL NCISION: incision Iine Middle umbilical from xiphoid
until the navel Appendix
MCBIJRNEY INC|SION: Above the iliac spine anterosuperior
PARAMEDIAL INCISION: parallel to the alba
INGUINAL INCISION
INCISION INFRAUMBILICAL: The incision line Middle umbilical has
been dificult from the navel to the pubis

COLLATERAL CIRCUTATION: ln a normal person, circulation must be directed

toward the head above the navel and, below this, towards the feet. ln portal
hypertension, the veins are directed outwards in radially from the navel.
(circulation in medusa's head). In the obstruction of the inferior vena cava
venous network is more. manifest at the root of the.members and to the sides of
the abdominal wall, especially in vertical position and with efforts

NAVEL:
Observe your outline and location and any inflammation or protrusion that
makethink of a
hernia
The navel is usually umbilicado or flat.
.The navel has moved upward by intra-abdominll growths and
downwards by ascites (tanyol sign sign).
PILIFICACION:
The distribution of the pubic hair has arisen difference between men
than in women.
Man: you have a dianiond distribution, reaching the navel .
ln women: is triangular, without hair towards the navel.
SIGN OF CULTEN
Periumbilical ecchymosis
Capillary injury and prothrombin complex deficiency.
Signs of pancreatitis necrohemorragica and liver diseases

Sign of GRAY-TURNER (HALSTED)

The left flank ecchymosis.
Capillary injury and prothrombin complex deficiency
.Signs of pancreatitis necrohemorragica and liver diseases