Abdo Surface Anatomy Flashcards
Significance of the
- linea alba
- linea semilunaris
Both are aponeuroses of EO, IO, TA, RA
How would you locate the
- inguinal canal
- internal inguinal ring
- external inguinal ring
- inf epigastric
- superficial and deep circumflex iliacs
ASIS <=> pubic tubercle
- midpoint = internal inguinal ring
- sup to pubic tubercle - superficial inguinal ring
Medial to internal ring - inf epigastric
Lateral to internal ring - superficial and deep circumflex iliacs
Attachment of the
- EO, IO, TA
- RA
Layers of the abdominal wall
- below umbilicus
- above umbilicus
EO, IO, TA
-costal margin - linea semilunaris - inguinal ligament - iliac crest
RA
-xiphoid - costal margin - pubic crest
Layers under umbilicus
Skin - Campers fascia - Scarpas fascia - RA - EO - IO - TA - Peritoneum
Layers above umbilicus - only 1 type of connective tissue
Abdominal plane levels and how to locate them
- transpyloric - significance of this plane
- subcostal
- supracristal
Transpyloric - L1
-hands breadth under xiphoid
Passes through
-pylorus, neck of pancreas, DJ flexure, kidney hila
Subcostal - L3
-under lowest part of costal margin
Supracristal - L4
-across iliac crests
Can you palpate the following and how would you do so
- AA
- desc colon
- kidneys
- liver
- spleen
- GI tract
- uterus, ovaries
- bladder
- gall bladder
AA - above umbilicus at midline with both hands
- pulsatile - :)
- expansile - AAA?
Desc colon - LIF if last bowel mv not recent
Kidney - sandwich flanks between both hands, feel for downward mv as patient breathes in
Not palpable if healthy
Liver - slowly mv up right side of abdo, asking patient to breathe deeply
Spleen - slowly mv diagonally from RIF => LH, asking patient to breathe deeply
- if palpable => 3x normal size
- R9-11
GI tract - if chronically constipated
Uterus, ovaries - masses rise up from iliac fossa
-gravid uterus palpable from 12wks
Bladder - if full
Gall bladder - if inflammed/cancer
Positions and dermatomes of
- T6
- T10
- L1
T6 - across xiphoid
T10 - umbilicus
L1 - inguinal region, lower back
Assessing direction of superficial venous blood flow -how would you do this Direction -normal people -in portal HTN -caval obstruction
Place 2 fingers on vein to occlude flow
Empty vein whilst pressing down
Release 1 finger
If it refills, blood flowing towards held down finger
Normal - 2 possible roots but most blood goes deep
Paraumbilical => portal vein => IVC
Paraumbilical => thoracoepigastric => lateral thoracic => axillary => subclavian => SVC
Portal HTN - deep route has more resistance from cirrhosis
-round ligament reopens so increased superficial blood flow => caput medusa
Paraumbilical => sup => inf epigastric => femoral => ext iliac => common iliac => IVC
Paraumbilical => thoracoepigastric => lateral thoracic => axillary => subclavian => SVC
SVCO
Portal vein => IVC
Round ligament => paraumbilical => sup, inf epigastric => femoral => ext iliac => common => IVC
IVCO
Round ligament => paraumbilical => => thoracoepigastric => lateral thoracic => axillary => SC => BC => SVC
Azygos => SV
Approach for a liver biopsy
-2 possible approaches
Subcostal
- ask patient to hold breath to push liver down
- approach from underneath
Transthoracic
-MAL 8-10R approach
Vertebral level of the kidney hila
- L
- R
How to identify the ureters
-route of the ureters
L - L1
R - L1-2
Cross lumbar transverse spines at L3-5
-over psoas major, over ext iliac, under umbilical ligament
Referred pain location in -foregut -midgut -hindgut Why?
Referred pain location in
- gall bladder
- Meckel’s diverticulum
- appendix
- renal colic
Foregut - epigastric
Midgut - umbilical
Hindgut - superopubic
Diffuse pain from visceral peritoneum
Gall bladder - shoulder, back -GB irritates phrenic nerve Meckel's diverticulum/appendicitis -pain localised below umbilicus => RIF Renal colic - loin to groin
Why do patients who have had laparoscopy sometimes complain of pain in their shoulders
Irritation of phrenic nerve caused by insufflated CO2
Common side effect
Lymphatic drainage of
- testicle
- scrotum
- vulva
Testes => paraaortic
Scrotum, vulva => inguinal
How would you access the bladder without piercing the peritoneum
Bladder is infraperitoneal
Peritoneum only covers back 1/3d
Wait for bladder to fill up, approach from underneath
Describe the path of the testicle into the scrotum
Difference between direct and indirect hernias
Initially between peritoneum and TA
Passes through gap in TF
Pushes TA, IO, EO, skin through
Direct - through superficial ring through weakened TF
Indirect - though deep and superficial ring
