Surface Anatomy - Abdomen Flashcards by Daniel Part

How can we define the quadrants of the abdomen?

One vertical line through the umbilicus

One horizontal line through the umbilicus

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How can we define the 9 regions of the abdomen?

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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What is the superior boundary of the abdomen?

The thoracic outlet:

Xiphoid process
Costal margin

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What rib forms the lowest part of the costal margin?

Rib 10

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Where is the tip of rib 11 palpable?

Just anterior to midaxillary line

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Where is the tip of rib 12 level with?

Spinous process of L1

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What forms the inferior boundary of the abdomen?

Pubic bones

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What forms the posterior boundary of the abdomen?

Lumbar vertebral bodies

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How can the spinous processes be more easily palpated?

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

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Where can the transverse processes of lumbar vertebrae be palpated?

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

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What muscles form the walls of the abdominal cavity?

External obliques
Internal obliques
Transversus abdominis
Rectus abdominis
Quadratus lumborum

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What muscle forms the roof of the abdominal cavity?

Diaphragm

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What muscle forms the floor of the abdominal cavity?

Pelvic diaphragm

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What muscles of the abdomen cannot be palpated? Why?

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

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How can rectus abdominis be palpated?

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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How can the right external oblique be palpated?

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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How can the left internal oblique be palpated?

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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How can quadratus lumborum be palpated?

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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How can the erector spinae be palpated?

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

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

Lie too deep within abdominal cavity

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

Deep nerves are too deep to palpate

Superficial nerves are too small to palpate

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What are the superficial nerve branches to the abdominal wall?

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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How can the aorta be palpated?

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

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What are the surface markings of the abdominal aorta?

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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What is the supracristal plane?

A transverse plane roughly at the level of L4 vertebra

What happens to the aorta at the supracristal plane?

Bifurcates into the common iliac arteries

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

``` T12 Via aortic hiatus of diaphragm With: - Azygos vein - Thoracic duct ```

Can the large veins of the abdomen be palpated?

No - they are too deep

What are the surface markings of the IVC?

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

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

T8 | Caval opening

What are the dimensions of the spleen?

10cm long 7cm wide 3-4cm thick

Where does the spleen lie?

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

Is the spleen normally palpable?

What are the functions of the spleen?

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

What region of the abdomen does the liver fill?

Right hypochondrium

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

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

Where does the upper border of the liver lie?

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

Where does the lower border of the liver lie?

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

Can the liver be normally palpated?

Not easily | Can be percussed

What is the diameter of the gallbladder?

3cm

Where does the gallbladder lie?

Midclavicular line on right 9th costal cartilage

What is the function of the gallbladder?

Storage and release of bile

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

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

How does the stomach vary?

In size and shape between individuals | Whether its full or not

Where can the stomach be palpated when its full?

On left side below costal margin

Where can the stomach be palpated when empty?

Cannot be palpated: | - Is lying completely behind rib cage

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

``` 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 ```

Where can the fundus lie in its extremes?

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

How long is the duodenum?

~25cm

Where does the duodenum run from and to?

From pyloric valve to the jejunum

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

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

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

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

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

Crosses 10cm to the left side across L3 vertebral body

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

Ascends 2.5cm to duojejunal junction: - L2 - 2cm left of midline

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

2nd part

What are the dimensions of the pancreas?

10cm long | 4cm wide

What is the course of the pancreas?

Crosses from right to left anterior to vertebral body of L1

What are the relations of the head of pancreas?

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

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

Transpyloric plane

What is the body of the pancreas related to?

Superior mesenteric vein | Splenic vein

What does the tail of the pancreas abut into?

Hilum of spleen

Is the spleen normally palpable?

Which large vein is formed posterior to the spleen?

IVC from junction of: - Splenic vein - Superior mesenteric vein

How long is the small intestine?

Where does the jejunum start?

L2 | Just to left of midline

Where does the small intestine end?

Iliocaecal junction: | - Lies at junction of right midclavicular and transtubercular line

What blood vessels supply the small intestine?

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

Where does the caecum lie?

Right iliac region | Above lateral half of right inguinal ligament

Where does the appendix lie?

Midclavicular line | 1.5cm medial to ASIS

Are the caecum and appendix usually palpable?

Where is pain from the appendix referred?

Umbilicus initially | As it swells from inflammation, pain moves down to RIF

Where does the ascending colon run?

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

Where does the transverse colon run?

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

Where does the descending colon run?

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

Where does the sigmoid colon run?

Forms an 's-shape' | Passes backwards and down the sacrum to the pelvic floor where it becomes the anal canal

Is the large intestine palpable?

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

``` Left: - Ribs 11 and 12 Right: - Rib 12 - Lower because of liver ```

What are the dimensions of a kidney?

11cm long 6cm wide 3cm thick

Where does the hilum of each kidney lie?

~L1 level | ~3cm from midline

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

Upper margin = T12 | Lower margin = L3

Where does the lateral border of each kidney lie?

~6.5cm from midline

What part of the kidneys can be palpated? Where?

Lower pole of right kidney by deep pressure: - Just lateral to midclavicular line - Just below level of right 10th rib

Where does the bladder usually lie?

Behind bodies of pubic bones

Where does the bladder rise to as it fills?

Rises ~3cm above pubic bones

Where can the bladder be palpated when full?

Just superior to pubic symphysis

What organs can be visualised with median and paramedian incisions?

Often exploratory: | - Therefore visualise all abdominal organs

What organs can be accessed by gridiron and transverse incisions?

Appendix | Caecum

Which incision is preferable, gridiron or transverse?

Transverse: | - Gridiron incision is oblique = Worse scar as it crosses Langer's lines

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

Uterus Bladder (Prostate)

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

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

Surface Anatomy - Abdomen Flashcards

(90 cards)