Living Anatomy

Question 1

Which abdominal organs are protected by the ribcage?

Answer 1

1) Kidneys
2) Liver
3) Spleen
4) Most of stomach

Question 2

What is the superior margin of the abdominal wall?

Answer 2

The xiphoid process, along the costal margin to the 12th rib posteriorly

Question 3

What is the inferior margin of the abdominal wall?

Answer 3

Pubic tubercle and crest, along the inguinal ligament to the ASIS

Question 4

The linea alba and linea semilunaris mark the boundaries of which structure?

Answer 4

Rectus abdominis muscle

Question 5

What Is the significance of the linea alba in surgery?

Answer 5

Median incision through the linea alba is a common surgical approach because It consists mostly of connective tissue and doesn’t contain any primary nerves or blood vessels

Question 6

How many regions is the abdominal wall divided into during clinical examination and which lines divide it?

Answer 6

2 vertical and 2 horizontal lines

1) 2 vertical lines in the midclavicular lines
2) Horizontal line called the subcostal line which joins the most inferior parts of the costal margin
3) Horizontal line called the transtubercular line passes through the tubercles of the iliac crest (about 5cm posterior to the ASIS)

Question 7

What are the regions of the abdomen?

Answer 7

1) Right hypochondrium - Epigastrium - Left hypochondrium
2) Right lumbar - Umbilical - Left lumbar
3) Right iliac - Hypogastric (suprapubic) - Left iliac

Question 8

At what vertebral level does the subcostal line lie?

Answer 8

L3

Question 9

At what vertebral level does the transtubercular line lie?

Answer 9

L5

Question 10

Where does the transpyloric plane lie in relation to other structures?

Answer 10

Halfway between the manubrium and the pubis

Question 11

At what vertebral level does the transpyloric plane lie and what structures does it pass through in the abdomen?

Answer 11

L1

1) Pylorus of stomach
2) Hila of kidneys
3) Duodenaljejunal junction
4) Neck of the pancreas

Question 12

What are the 3 stages palpation is performed in?

Answer 12

1) Light palpation
2) Deep palpation
3) Organ specific palpation

Question 13

When performing an abdominal examination what is guarding?

Answer 13

Reflex tensing of the abdominal muscles over the painful area

Question 14

What is light palpation useful for?

Answer 14

Determining if there are any signs of tenderness

Question 15

What is deep palpation useful for?

Answer 15

To locate any abnormal swellings

Question 16

What is a solid mass felt in the left lumbar region during deep palpation likely to be?

Answer 16

Faeces in the sigmoid colon

Question 17

What is tenderness at McBurney’s point during deep palpation indicate?

Answer 17

Appendicitis

Question 18

Why is palpation of the kidneys, liver and spleen not normally possible in a healthy individual?

Answer 18

They are protected by the thoracic cage

Question 19

What is hepatomegaly?

Answer 19

Enlarged liver

Question 20

Where does the liver enlarge towards in hepatomegaly?

Answer 20

The right iliac fossa

Question 21

Why should palpation of the liver be synchronised with respiration?

Answer 21

Position of the liver changes with respiration
Can move 4-8 cm down in midline
Can move 6-12 cm down in right midclavicular line

Question 22

What is Murphy’s sign and what does it indicate?

Answer 22

Arrest of inspiration when 2 fingers are layered over the RUQ and the patient is asked to inspire. Pain and arrest of inspiration occurs as the gall bladder impinges on your fingers
May indicate cholecystitis

Question 23

In what direction does the spleen enlarge?

Answer 23

Towards the right iliac fossa, crossing the abdomen diagonally

Question 24

By how much must the spleen enlarge to be palpable?

Answer 24

3 fold - if palpable, always indicative of splenomegaly

Question 25

What prevents the spleen from enlarging inferiorly into the left iliac fossa?

Answer 25

The phrenocolic ligament

Question 26

What technique is used to palpate the kidneys?

Answer 26

Bimanual technique

Question 27

What is balloting in terms of the kidney and what does it demonstrate?

Answer 27

Moving the inferior pole of the kidney between your hands, it demonstrates the mobility of the kidney

Question 28

In what direction does the normal abdominal aortic pulse push the fingers?

Answer 28

Upwards

Question 29

What is an expansile aortic pulse and what may it indicate?

Answer 29

Fingers are pushed laterally when palpating the abdominal aorta
May indicate an abnormal aortic aneurysm

Question 30

What is an AAA and why should it be monitored?

Answer 30

Dilation of the abdominal aorta

Causes no symptoms unless it ruptures, a ruptured AAA is often fatal