Several important large arteries are found retroperitoneally in the abdomen, such as the aorta, which branches to the kidneys (renal arteries) and the abdominal organs (coeliac trunk and the superior and inferior mesenteric arteries). The bifurcated aorta lies at the level of the navel, at which point the aorta divides to become the left and right iliac arteries, which turn into the femoral arteries.
General
Abdominal pain can be caused by transient ischaemia (abdominal angina). This can occur after eating or in certain positions. Determine whether there are other indications of arteriovascular disease.
Ischaemia and necrosis of the intestine can lead to serious complications.
Measure blood pressure (renal artery stenosis can cause hypertension).
Inspection
During inspection, look for visible pulsations. In slender patients, pulsations of the aorta are usually visible.
Auscultation
Procedure
- Listen above all of the major vessels [Figure 47]. If the abdominal pain depends on a certain position, also listen while the patient is in this position.
Figure 47: Auscultation points – major arteries
- abdominal aorta
- bifurcation
- iliac arteries
- femoral arteries
- renal arteries
Focus points
- Note whether murmurs can be heard.
Palpation
Procedure
- Check for pulsations along the length of the aorta.
- Place the hands on both sides of the aorta with the fingers pointing cranially [Figure 48] and determine in this manner the perimeters of the pulsating mass on each side. Determine the width (in cm).
Figure 48
- Palpate the branches to both legs down to the groin, and compare left with right [Figure 49]
Figure 49
- If a vascular disorder is suspected, feel and compare the arterial pulsations in the popliteal space and feet (see the section ‘The Cardiovascular Examination’).
Focus points
- The aorta is normally no wider than 2.5 cm.
The thickness of abdominal tissue can make the aorta seem wider. A more accurate assessment requires additional tests. - If a pulsating mass is felt in the middle of the abdomen, a distinction should be made between transmitted pulsations (a tumour located before the aorta) and an actual pulsating mass (aneurysm).
Palpation of the flank may be helpful in this case: an aneurysm pulsates in all directions (expansile pulsation), whereas pulsations caused by a tumour cannot be felt in the flank (transmitted pulsation).