Chapter 9: Table of Contents
Exploring the Abdominal Organs
When exploring the abdominal cavity, make a plan and stick to it. If you find something abnormal, keep exploring and come back to it once you have seen everything; this will ensure that all organs are examined. Different exploration techniques are described in the literature; the quadrant technique and the ordered exploration are most commonly used. I examine and palpate the abdominal structures in a specific order (I always do it the same way: I begin with the liver, and move onto the gall bladder (I gently express the gall bladder), biliary tree, stomach and pylorus, proximal duodenum, pancreas (right limb and then left limb of the pancreas), distal duodenum, jejunum, ileum, cecum and colon. If the intestines are difficult to follow, pick-up any loop of jejunum, follow it in one direction until the colon or duodenum is reached and then follow it again in the opposite direction. Make sure to examine the mesenteric lymph nodes at the base of the mesentery. Then, examine each of the kidneys, adrenal glands (the right adrenal is often palpable but not visualized), (+/- ureters), urinary bladder, prostate and inguinal rings. I typically finish the exploration with the spleen but if the spleen is large, I look at it before running the bowel since it generally has to be moved out of the way to inspect the intestines. Specific lymph nodes are examined with their associated structures (e.g. mesenteric lymph nodes are examined with the small intestines). I look and palpate each structure for thickening, enlargement, irregularity, etc. While exploring, make sure to cover any exteriorized organs with moist laparotomy sponges to prevent tissues from drying out.