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Anatomy of the Individual > Surface Anatomy - Abdomen > Flashcards

Surface Anatomy - Abdomen Flashcards

1
Q

How can we define the quadrants of the abdomen?

A

One vertical line through the umbilicus

One horizontal line through the umbilicus

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2
Q

How can we define the 9 regions of the abdomen?

A 
Draw the 2 midclavicular lines:
- From midpoint of clavicle
- To midpoint of inguinal ligament
- On both sides
Draw the transpyloric plane:
- Horizontally from level of tips of 9th costal cartilages
Draw the transtubercular line:
- Horizontally across tubercles of iliac crest (upper L5 VB)
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3
Q

What is the superior boundary of the abdomen?

A

The thoracic outlet:

  • Xiphoid process
  • Costal margin
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4
Q

What rib forms the lowest part of the costal margin?

A

Rib 10

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5
Q

Where is the tip of rib 11 palpable?

A

Just anterior to midaxillary line

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6
Q

Where is the tip of rib 12 level with?

A

Spinous process of L1

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7
Q

What forms the inferior boundary of the abdomen?

A

Pubic bones

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8
Q

What forms the posterior boundary of the abdomen?

A

Lumbar vertebral bodies

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9
Q

How can the spinous processes be more easily palpated?

A

By asking someone to lie prone and placing a pillow under their abdomen

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10
Q

Where can the transverse processes of lumbar vertebrae be palpated?

A

5cm lateral to spinous processes
Just beyond bulk of erector spinae muscles:
- Deep palpation = May be uncomfortable

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11
Q

What muscles form the walls of the abdominal cavity?

A 
External obliques
Internal obliques
Transversus abdominis
Rectus abdominis
Quadratus lumborum
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12
Q

What muscle forms the roof of the abdominal cavity?

A

Diaphragm

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13
Q

What muscle forms the floor of the abdominal cavity?

A

Pelvic diaphragm

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14
Q

What muscles of the abdomen cannot be palpated? Why?

A

Roof (diaphragm)
Floor (pelvic diaphragm)
They are too deep

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15
Q

How can rectus abdominis be palpated?

A

Ask someone to lie supine
Place one hand above and one hand below of their umbilicus
Ask them to raise their head and shoulders off floor
A column of muscle either side of the midline = Rectus abdominis

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16
Q

How can the right external oblique be palpated?

A

Ask someone to lie supine
Ask them to rotate their trunk to the left
Oppose rotation by holding their right shoulder gently
Palpate near right iliac crest = Attachment of right external oblique will tighten

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17
Q

How can the left internal oblique be palpated?

A

Ask someone to lie supine
Ask them to rotate their trunk to the left
Oppose rotation by holding their right shoulder gently
Palpate between left iliac crest and umbilicus

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18
Q

How can quadratus lumborum be palpated?

A

Ask someone to lie prone
Ask them to raise shoulders
Anterior border of quadratus lumborum can be palpated just posterior to the midaxillary line

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19
Q

How can the erector spinae be palpated?

A

Ask someone to lie prone
Ask them to raise their head and shoulders
Palpate just lateral to lumbar spines

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20
Q

Why can most of the large neurovascular structures of the abdomen not be palpated?

A

Lie too deep within abdominal cavity

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21
Q

Why can the deep and superficial nerves of the abdomen not be palpated?

A

Deep nerves are too deep to palpate

Superficial nerves are too small to palpate

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22
Q

What are the superficial nerve branches to the abdominal wall?

A 
Anterior and lateral cutaneous branches of:
- Thoracoabdominal (T7-T11) nerves
- Subcostal (T12) nerve
Cutaneous branches of:
- Iliohypogastric (L1) nerve
- Ilioinguinal (L1) nerve
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23
Q

How can the aorta be palpated?

A

Compress against lumbar vertebrae by pressing down with both hands just lateral to midline

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24
Q

What are the surface markings of the abdominal aorta?

A

Vertical line to left of midline of the trunk:

  • Runs from 2.5cm above transpyloric line
  • Runs to 2.5cm below supracristal plane
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25
Q

What is the supracristal plane?

A

A transverse plane roughly at the level of L4 vertebra

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26
Q

What happens to the aorta at the supracristal plane?

A

Bifurcates into the common iliac arteries

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27
Q

At what level does the aorta enter the abdominal cavity? Via what and with what other structures?

A 
T12
Via aortic hiatus of diaphragm
With:
- Azygos vein
- Thoracic duct
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28
Q

Can the large veins of the abdomen be palpated?

A

No - they are too deep

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29
Q

What are the surface markings of the IVC?

A

Vertical line just to right of midline:

  • From 2.5cm below supracristal plane (union of common iliac veins)
  • To just above right 6th costal cartilage
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30
Q

At what level does the IVC leave the abdomen? Via what?

A

T8

Caval opening

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31
Q

What are the dimensions of the spleen?

A

10cm long
7cm wide
3-4cm thick

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32
Q

Where does the spleen lie?

A

On the left side
Posterior to ribs 9-11
Near midaxillary line

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33
Q

Is the spleen normally palpable?

A

No

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34
Q

What are the functions of the spleen?

A 
Lymphocyte proliferation
Immune surveillance
Haematopoiesis:
- Prenatally
- In times of bone marrow stress
Haemolysis
Destruction of old platelets
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35
Q

What region of the abdomen does the liver fill?

A

Right hypochondrium

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36
Q

Describe the size of the right and left lobes of liver?

A

Right lobe is large

Left lobe is small and tapers towards left side of abdominal cavity

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37
Q

Where does the upper border of the liver lie?

A

On the left:
- 7cm to left of xiphisternal joint
On the right:
- From xiphisternal joint all the way around the right side of the thoracic cage

38
Q

Where does the lower border of the liver lie?

A

Passes in oblique line from:

  • 7cm left of the midline
  • To 8th costal cartilage on left
  • Follows the border of the costal margin around to the right
39
Q

Can the liver be normally palpated?

A

Not easily

Can be percussed

40
Q

What is the diameter of the gallbladder?

A

3cm

41
Q

Where does the gallbladder lie?

A

Midclavicular line on right 9th costal cartilage

42
Q

What is the function of the gallbladder?

A

Storage and release of bile

43
Q

Can the gallbladder be palpated? When may it be palpable?

A

Not easily
Murphy’s sign:
- Pain on inspiration when palpating below right costal margin
- Due to cholecystitis

44
Q

How does the stomach vary?

A

In size and shape between individuals

Whether its full or not

45
Q

Where can the stomach be palpated when its full?

A

On left side below costal margin

46
Q

Where can the stomach be palpated when empty?

A

Cannot be palpated:

- Is lying completely behind rib cage

47
Q

What are the fixed portions of the stomach and where do they li?

A 
Cardiac orifice:
- Along 7th costal cartilage
- 2.5cm to left of midline
- Level with xiphoid process
Pyloric orifice:
- On transpyloric plane (tip of 9th costal cartilage)
- 1.5cm to right of midline
48
Q

Where can the fundus lie in its extremes?

A

May rise as high as the 5th intercostal space, 7cm to left of midline
May lie as far down as the 10th costal cartilage

49
Q

How long is the duodenum?

A

~25cm

50
Q

Where does the duodenum run from and to?

A

From pyloric valve to the jejunum

51
Q

What is the course of the 1st part of the duodenum?

A

From pylorus, it passes 5cm to right side as far as costal margin

52
Q

What is the course of the 2nd part of the duodenum?

A

Passes down and to the left for 7.5cm to the 10th costal cartilage

53
Q

What is the course of the 3rd part of the duodenum?

A

Crosses 10cm to the left side across L3 vertebral body

54
Q

What is the course of the 4th part of the duodenum?

A

Ascends 2.5cm to duojejunal junction:

  • L2
  • 2cm left of midline
55
Q

Which part of the duodenum is the ampulla of Vater found?

A

2nd part

56
Q

What are the dimensions of the pancreas?

A

10cm long

4cm wide

57
Q

What is the course of the pancreas?

A

Crosses from right to left anterior to vertebral body of L1

58
Q

What are the relations of the head of pancreas?

A

Surrounded by duodenum
Related to:
- IVC
- Right crus of diaphragm

59
Q

On what plane does the body of the pancreas lie on?

A

Transpyloric plane

60
Q

What is the body of the pancreas related to?

A

Superior mesenteric vein

Splenic vein

61
Q

What does the tail of the pancreas abut into?

A

Hilum of spleen

62
Q

Is the spleen normally palpable?

A

No

63
Q

Which large vein is formed posterior to the spleen?

A

IVC from junction of:

  • Splenic vein
  • Superior mesenteric vein
64
Q

How long is the small intestine?

A

8m

65
Q

Where does the jejunum start?

A

L2

Just to left of midline

66
Q

Where does the small intestine end?

A

Iliocaecal junction:

- Lies at junction of right midclavicular and transtubercular line

67
Q

What blood vessels supply the small intestine?

A

Duodenum:
- Superior pancreaticoduodenal artery (from gastroduodenal)
- Inferior pancreaticoduodenal artery (from SMA)
Jejunum:
- Jejunal arteries from SMA
Ileum:
- Ileal arteries from SMA

68
Q

Where does the caecum lie?

A

Right iliac region

Above lateral half of right inguinal ligament

69
Q

Where does the appendix lie?

A

Midclavicular line

1.5cm medial to ASIS

70
Q

Are the caecum and appendix usually palpable?

A

No

71
Q

Where is pain from the appendix referred?

A

Umbilicus initially

As it swells from inflammation, pain moves down to RIF

72
Q

Where does the ascending colon run?

A

From caecum in RIF to level of transpyloric plane (forming hepatic flexure)

73
Q

Where does the transverse colon run?

A

Through umbilical region to form splenic flexure just above transpyloric plane on left side

74
Q

Where does the descending colon run?

A

Down from splenic flexure into inguinal region where it becomes the sigmoid colon

75
Q

Where does the sigmoid colon run?

A

Forms an ‘s-shape’

Passes backwards and down the sacrum to the pelvic floor where it becomes the anal canal

76
Q

Is the large intestine palpable?

A

No

77
Q

What ribs protect the kidneys? Why is one lower than the other?

A 
Left:
- Ribs 11 and 12
Right:
- Rib 12
- Lower because of liver
78
Q

What are the dimensions of a kidney?

A

11cm long
6cm wide
3cm thick

79
Q

Where does the hilum of each kidney lie?

A

~L1 level

~3cm from midline

80
Q

What vertebral levels do the upper and lower poles of the kidneys lie at?

A

Upper margin = T12

Lower margin = L3

81
Q

Where does the lateral border of each kidney lie?

A

~6.5cm from midline

82
Q

What part of the kidneys can be palpated? Where?

A

Lower pole of right kidney by deep pressure:

  • Just lateral to midclavicular line
  • Just below level of right 10th rib
83
Q

Where does the bladder usually lie?

A

Behind bodies of pubic bones

84
Q

Where does the bladder rise to as it fills?

A

Rises ~3cm above pubic bones

85
Q

Where can the bladder be palpated when full?

A

Just superior to pubic symphysis

86
Q

What organs can be visualised with median and paramedian incisions?

A

Often exploratory:

- Therefore visualise all abdominal organs

87
Q

What organs can be accessed by gridiron and transverse incisions?

A

Appendix

Caecum

88
Q

Which incision is preferable, gridiron or transverse?

A

Transverse:

- Gridiron incision is oblique = Worse scar as it crosses Langer’s lines

89
Q

What organs can be accessed by a suprapubic (Pfannenstiel) incision?

A

Uterus
Bladder
(Prostate)

90
Q

What organs can be accessed by subcostal (Kochner) incisions?

A 
Right:
- Gallbladder
- Liver
- Biliary tree
Left:
- Oesophagus
- Stomach
- Spleen

Anatomy of the Individual (10 decks)

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