Living Anatomy of the Abdomen Flashcards
(43 cards)
Where does the superior margin of the abdominal wall pass from?
From the xiphoid process, along the costal margins to the 12th rib posteriorly.
Where does the inferior margin of the abdominal wall pass?
From the pubic tubercle and crest, along the inguinal ligament to the anterior superior iliac spine (ASIS
What abdominal organs are protected by the thoracic cage?
- Liver
- Spleen
- Stomach (cardia and fundus)
- Kidneys (superior poles)
The linea alba and linea semilunaris mark the boundaries of what structure?
Medial and lateral boundaries of the rectus sheath which contains the rectus abdominis muscle.
What is the clinical significance of the linea alba in surgery?
Provides a relatively avascular plane to make a midline incision thus minimising blood loss.
However, poor blood supply to the linea alba can mean that it does not heal well.
How many regions can the abdomen be divided into during clinical exams?
9 (2 vertical and 2 horizontal lines)
What are the vertical lines that divide the abdomen?
The left and right mid clavicular lines
What are the horizontal lines that divide the abdomen?
The subcostal and transtubercular lines
Describe the subcostal line
More superior and joins the most inferior points of the costal margins
Describe the transtubercular line
Passes through the tubercles of the iliac crest (approximately 5cm posterior to the ASIS).
At what vertebral level does the subcostal line lie?
L3
At what vertebral level does the transtubercular line lie?
L5
What are the 9 regions of the abdomen?
Right Hypochondrium Epigastrium Left Hypochondrium Right Lumbar Umbilical Left Lumbar Right Iliac Hypogastrium Left Iliac
Where is the transpyloric plane?
Halfway between the manubrium and the pubis
Lies at L1
What does the transpyloric plane pass through?
Pylorus of stomach and 1st part of duodenum
Fundus of gallbladder
Neck of pancreas
Origin of SMA
Origin of hepatic portal vein
Root of transverse mesocolon
Hila of kidneys
How is abdomen palpation performed?
- Light palpation
- Deep palpation
- Organ-specific palpation
How is light palpation performed?
Placing the right hand on the abdominal wall and gently flexing the metacarpophalageal joints (knuckles) as shown in the diagram below. You should palpate ALL nine regions ensuring that none are omitted.
Useful in determining if there are any regions of tenderness
What is guarding?
Contraction of the abdominal muscles to protect the underlying viscera during palpation, particularly if there is pain.
What is deep palpation?
Pressing harder with the right hand or using both hands together as shown below.
A solid mass may be felt in left lumbar region during deep palpation. What is this likely to be?
Faeces in descending colon
Where is McBurney’s point?
Located 1/3 of the way from the ASIS to the umbilicus
What would tenderness in at McBurney’s point during palpation indicate?
This is the location of the base of the appendix therefore pain here indicates appendicitis.
When is organ specific palpation performed?
Performed to check for any enlargement. This includes palpation of the liver, spleen, kidneys. These organs are not usually palpable in healthy individuals unless very thin. This is because they are protected by the thoracic cage.
Describe the relation of the spleen to the thoracic wall
The spleen lies deep to ribs 9-11 and is well protected by the thoracic wall. Although mobile, the spleen does not move below the costal margin even during deep inspiration therefore it is not normally palpable.
