Abdomen 1 and 2: (Complete) Flashcards
State the regions of the 2 vertical and 2 horiontal lines that split the abdomen into 9 regions.
Vertical: Left and Right midclavicular vertical planes
Horizontal: Subcostal and Intertubercular horizontal planes
Name the 9 divisions of the abdomen
Right hypochondriac
Epigastric
Left hypochondriac
Right lumbar
Umbillicus
Left Lumbar
Right inguinal
Suprapubic
Left inguinal
The subcostal plane is located at which vertebral level?
L3
The intertubercular plane is located at which vertebral level?
L5
The ASIS is located at which vertebral level?
S2
How is the transpyloric plane determined and what vertebral level is it?
Transpyloric is midway between sternal border (superior border of manubrium) and the pubic symphysis
L1
State how to divide the abdomen into four quadrants?
Vertical line from umbilicus and horzitonal line from umbillicus
Vertical line: Sagittal plane
Horizontal line: Transumbilical plane
How can you find the supracristal plane and what vertebral level is it located?
Located at the highest point of the iliac crest
Vertebral level L4
The muscles and skin of the anterolateral abdominal walls is innervated by which nerves?
Anterior rami of thoracic nerves T7-12
The groin is innervated by which nerves?
L1 spinal nerve
The perineal area is innervated by which nerves?
S3 and S4 spinal nerves
The epgastric region is innervated by which 2 spinal nerves?
T7
T8
The umbilical region is innervated by which spinal nerves?
T10
Describe the movements of the abdominal wall, liver, kidney and spleen during inspiration
Abdominal wall: Moves outwards
Liver, kidney and spleen: Move downwards
Distended and everted umbilicus may indicate?
Umbilical hernia
Abnormally enlraged veins on the abdominal wall may indicate either which of two things?
Portal hypertension or obstructed inferior vena cava
Assymetry of abdominal wall may indicate?
A localised mass
Abdominal swelling should be considered caused by which two things?
Ascites (fluid collection in peritoneal cavity)
Bowel obstruction
Tenderness with minimal pressure over a wider area of the abdomen may be due to which two things?
Anxiety
Peritonitis
Voluntary contraction in response to palpation causing pain is known as?
Voluntary guarding
What is a involuntary guarding of the abdominal wall and what does it indicate?
A reflex contraction in which the abdominal wall shows minimal if any movement during respiration
Usually indicated inflammation of the peritoneum
If there is sharp pain induced when the abdominal wall is compressed slowly and then released suddenly, this is usually indicative of? What is this known as?
Generalised or localised peritonitis
This is known as rebound tenderness
Rebound tenderness is indicative of?
Peritonitis
What are the two main objectives of auscultation?
Detecting bowel sounds
Identifying vascular bruits
Describe normal bowel sounds and what it is caused by?
Gurgling sounds
Due to peristalsis of GI tract
Bowels sounds should be listened for how long?
2 mins
1 minute minimally
Give two examples of conditions in which bowel sounds may be absent?
Peritonitis
Parylitic ileus
Describe the type of bowel sounds that are indiciative of bowel obstruction
High pitched and frequent
Vascular bruits are caused by?
Turbulent blood flow due to aneurysm or obstruction
Where should the stethoscope be placed for vascular bruits of the abdominal aorta
Just above and left of umbilcus
Auscultate for vascular bruits of the superior mesenteric/coeliac arteries
Place stethoscope on epigastrum
Auscultate for vascular bruits of the renal arteries
Just 2-3cm above the umbillicus laterally
Auscultate the liver to check for liver tumors
Auscultate the iliac arteries for vascular bruits
Located in the iliac fossa
The liver is located mainly in which two of the nine abdominal regions?
Right hypochondriac and epigastrum
The upper surface of the liver is lies at which costal cartillage and intercostal level?
5th costal cartillage
5th intercostal space
N.B. At the midclavicular line
The lower border of the liver closely follows?
The costal cartillage
With some exceptions in individuals, usually the liver is not palpable. In hepatomegaly, where is the liver palpable?
Palpable in the right costal margin (Can be easily felt if patient is asked to fully inspire as the liver lies a bit more outwards)
The liver can never be felt in the epigastrum because of?
The rectis abdominis
The lower border of the liver can be palpated usually in which groups of patients?
Infants and children
The gallbladder cannot be palpated even if enlarged. Where is the fundus of the gallbladder located in surface anatomy?
tip of the right 9th costal cartillage
Locate the tip just below a point at which the lateral border of the rectus abdominis muscle intersects the costal margin in the transpyloric plane
Where is the tip of the 9th costal cartillage located?
Locate the tip just below a point at which the lateral border of the rectus abdominis muscle intersects the costal margin in the transpyloric plane
Give 2 examples of causes of gallbladder pain
Cholelithiasis
Cholecystitis
Describe the location of gallbladder pain in early and late stages?
Early: Epigastrium
Late: Right hypochondriac at tip of 9th costal cartillage (when palpated causes a ‘catch’ in breath)
Where is the spleen located in the 9 regions?
Left hypochondrium
The spleen is usually not palpable unless?
It extremely large (3-4 times the normal size)
In extreme cases, the spleen can be palpable at?
Below the left costal margin
State the 4 surface marking points of the liver.
1) Right 5th rib at midclavicular line
2) Lower end of sternum
3) left 5th intercostal at mid-clavicular line
4) Costal margin at right mid-axillary line
What are the 3 borders of the liver?
Upper border
Oblique border
Right border
Posteriorly, the spleen is located along?
On the left side (your left cus youre posterior facing)
Medial surfaces of the 9th, 10th and 11th ribs (you can feel 11th as floating then move up one to find 10th)
Between the mid-axillary line and the lateral border of the errector spinae muscles
State the surface markings of the spleen and outline the spleen
10th rib at the mid-axillary line
11th rib (palpate the anterior free end
Lateral border of the erector spinae muscle
Percussion of the liver first starts at and move inferiorly?
Starts at 4th intercostal space at mid-clavicular margin
Move down inferiorly, usually dull sounds of liver disapears at the right costal margin which indicates end of liver in normal person
Explain how to palpate the spleen
Start at right iliac fossa region with right hand feeling,
Palpate towards the left costal margin
Use the left hand to full the rib and spleen towards ur right hand for palpation
Explain how to precuss the spleen
Percussion will. be along the left anterior axillary line starting at 10th intercostal space (between 10th and floating rib 11)
You will percuss for both inspiration and expiration going downwards
What type of percussion sound indicates splenomegaly?
Percussion becomes dull on full inspiration
Identify and palpate the midpoint of the clavicle
Identify and palpate the costal margin
Identify and palpate the xiphisternal joint
Identify and palpate the L1-L5 vertebrae
Identify and palpate the intervertebral disk
What is the sagittal plane?
What is the coronal plane?
What plane is this CT scan showing?
Sagittal plane
What plane is this CT scan showing?
Coronal CT scan
What plane is this CT scan showing?
Transverse
How can you tell the difference between an MRI and CT scan?
CT scan shows bones as white and fat/water as black
MRI shows bones as black and fat/water as white
(Left is CT, right is MRI)
Demonstrate the midiguinal point
Between ASIS and pubic tubercle
Demonstrate the midpoint of the inguinal ligament
Between ASIS and pubic tubercle
The erector spinae muscle and the strip of skin that overlies it on the posterior abdominal wall is innervated by which group of nerves?
Posterior rami of thoracic spinal nerves
Memorise dermatome
Which part of the nervous system is responsible for innervation of abdominopelvic visceral organs?
Autonomic nervous system
Afferant pain fibres from abdomino-pelvic visceral organs exits alongisde sympathetic nerves within which spinal levels?
T1-L2
How does the umbillicus tend to look in obese patients?
Sunken umbilicus
If ever you do feel the livers edge in an unhealthy patient. What findings must you record?
Surface smooth or irregular?
Surface hard or soft?
Is there tenderness (pain)
Is there any pulsations?
The distance between the upper and lower limits of the liver is usually how many centimetres in a healthy adult?
Around 13cm
The spleen, when affected by disease, usually enlarges towards what direction of the abdomen
Enlarges from left costal margin, across the umbillicus and towards the right iliac fossa
(Hence why you start palpation from the right iliac fossa)
How can an enlarged spleen be identified over an enlarged kidney?
During splenic enlargement, its sharp upper border with a characteristic notch will be the leading edge of the organ which your palpating finger will encounter
What are the five causes of a distended abdomen?
Fluid (ascites)
Fat
Faces (Bowel obstrucion)
Fetus
Flatus
List the 4 most common causes of ascites (Excessive fluid in peritoneal cavity)
Hepatic cirrhosis
Portal hypertension
Liver malignancy
Peritoneal malignancy
List 8 less common causes of ascites
Cardiac failure
Peritonitis
Malnutrition
Hypoproteinaemia
Pancreatitis
Lmphatic obstruction
Hypothyroidism
Renal dialysis.
What does normal percussion of the abdomen sound and how does this change for patients with ascites?
Normal percussion will have a resonant sound due to gas in the bowels
Patients with ascites will have a dull sounds (starting intitally in the flanks) the more fluid, the more dullness will extend towards the midline of the abdomen.
Explain how you would assess for shifting dullness
Lay patient in supine position
Begin percussing from the midline out to the flanks on both sides
If fluid (dull sounds) is detected on a patients flank, you will ask the patient to lie on their side and wait for 30 seconds (for fluid to drain to opposite side)
Percuss the same area that was intially dull and observe for a now resonant sound.
If the sound is now resonant, this is known as shifting dullness and indicates ascites.
Remember to repet this on the opposite flank
If the abdomen is severely distended and the abdominal percussions is dull throughout, even after testing for shifting dullness, what test should be performed to determine if the reason for dullness is due to ascites?
Fluid thrill test
Explain how you would perform a fluid thrill test
place the palm of your left hand over the left side of patient’s abdomen
flick a finger of your right hand on the right side of the abdomen.
If you feel a ripple against your left hand, a fluid thrill is present.
Name the point which can be palpated to assess for appendicitis
McBurney’s point
2cm from ASIS towards the umbillicus
