abdomen Flashcards
what are the 9 regions of the stomach and what would you find in each region
right iliac fossa (appendix, cecum), suprapubic (bladder, uterus), left iliac fossa (sigmoid colon), left lumbar (kidney), umbilical (small bowel, retroperitoneal structures), right lumbar (kidneys), right hypochondriac (gall bladder), epigastric (stomach, duodenum,) , left hypochondriac (pancreas)
where is the spleen
intraperitoneal organ, left hypochondriac region, inbetween ribs 9-11
what are the causes of splenomegaly?
portal HTN secondary to liver cirrhosis, haemolytic anaemia, splenic metastases
why would both kidneys be enlarged
polycystic kidney disease,
why would only 1 kidney be enlarged?
renal tumour.
what is pathological when palpating the abdominal aorta
when your hand moves outwards- suggest expansile mass.
when does abdominal aorta bifourcate?
L4
what are you looking for in inspection
skin abnormalities, surgical scars, masses, hernias, assymetry. movement of abdo wall
what are some pathological changes to the abdomen
obesity- umbillicus is sunken
hernia: umbillicus is distended and everted
why would there be abnormally large veins on abdominal wall
portal HTN/ obstructed IVC.
why would there be assymetry in abdominal wall?
localised mass
tenderness on palpation
minimal presure over wide area due to peritonitis, and sometimes anxiety)
guarding
contract voluntarily when palpation causes pain
ridgidity
inflammation of parietal peritoneum, reflex contraciton (involuntary guarding). abdominal wall may not show any sign of movement
rebound tenderness
generalised or localised peritonitis, if abdominal wall is compressed slowly, then shapr stabbing pain when released
transpyloric plane
L1: pylorus of stomach, neck of pancreas, renal hilum
subcostal plane
L3: origin of IMA, lower edge of 10 CC
Supracristal plane
L4: bifourcation of aorta,
intertuburcular plane
L5: tubercle of crest of ilium
interspinous plane
S2: ASIS.
umbilicus plane
between L3-L4
what do you expect to hear from percussing the liver
resonant–> dull (Costal margin), dull–> resonant (4th rib ish). to find the upper border, tap above to the 4th rib and then come back down. could also palpate to find the upper border
when would you percuss hyperresonant
air-not good
ascites
accumulation of fluid in peritoneal cavity due to liver cirrhosis, as dec metabolism of aldosterone and ADH, so more salt and water retention in the body. also less albumin, so then less oncotic pressure, so less pull of fluid into tissue so more fluid in peritoneal cavity
absent bowel sounds
paralytic ileus/peritonitis
high pitched bowel sounds
intestinal obstruction
abdominal aorta bruits
above and left of umbillicus
SMA bruits
epigastrium
renal A bruits
2cm superior and lateral to umbillicus
liver tumours and iliac arteries
over liver and iliac fossa
surface marking of kidney:
4-5 cm from posterior median line–> supra cristal plane. hilum at L1 transpyloric plane
how big is the kidney
height: 9-12 cm, width: 5-7 cm
ureter surface marking
renal hilum is 5cm lateral to posterior median line at L1 (transpyloric plane) and goes through posterior superior iliac spine
surface marking of kidney
right 5th rib MCL, lower end of sternum, left 5th rib MCL (upper border), CM at right mid axillary line, (oblique/ diagonal border- left 5th ICS MCL to left 8th CC then to right 9th CC then to right mid axillary line in right costal margin) and then back up to right 5th rib MCL= right border
gall bladder surface marking
lateral border of rectus abdominis (transpyloric plane=L1) and right MCL
sites of kidney stones
pelvic-ureteric junction, pelvic brim, vesico-ureteric junction. US. small: pass in urine, large: stenting/ lithotripsy
surface marking of spleen
ribs 9-11, in between posterior mid axillary line and lateral border of erector spinae muscles
dermatomes of abdomen
T5: xiphoid process, T10: umbillicus. butt: S3
pneumoperitoneum
air under diaphragm due to perforation of abdo organ (trauma/iatrogenic causes)
SBO on xray
step ladder, more than 3 cm, centrally located, valvulae conniventes (go through the whole bowel), striations
LBO on xray
peripherally located, haustra
where does pain from 9 regions radiate to
right hypochondriac: through to the back and right. epigastric: straight to the back, left hypochondriac: through to the back and the left. kidneys: in loin and radiate to groin
what seperates the 9 regions horizontally:
subcostal plane-L3. intertuburcular plane: L5
causes of colicky pain
stones in urinary tract, gall stones in CBD, SBO/LBO
what caues constant pain
hepatitis, gastritis, any itis
what cases pain in right hyopchondriac region
gall stones, cholangiits, hepatitis, liver abscess
what causes pain in epigastric
oesophagitis, peptic ulcer, perforated ulcer, pancreatitis
what causes pain in left hypochondriac region
splenic abscess, acute splenomegaly, splenic rupture
what causes pain in umbillical
appendicitis (early), mesenteric adenitis
what causes pain in lumbar region
renal colic, ovarian cyst, ovarian mass, ovarian torsian
what causes pain in left iliac region
diverticulities, ulcerative collitis, hernia
what causes pain in right iliac region
appendicitis, crohn’s disease, renal colic
what causes pain in suprapubic region
urinary retention, cystitis, endometriosis
when do you use IV contrast
evaluate vascular disease, common, evaluate inflammation, masses, malignancies
when do you use oral contrast
allows distention of the bowel in order to distinguinsh the bowel from other sturctures. helpful in imaging the bowel wall/lumen
PC: appendicitis
acute RIF pain, dull periumbilical pain that shifts to RLQ pain (initially viseral peritoneum so poorly localised, then to parietal peritoneum which is better localised). anorexia, nausea, vomiting, constipation
Abdominal aortic aneurysm
wall of abdominal aorta is weakened, pt presents with shock and loss of consciousness.
signs of unruptured AAA
palpation of AAA will be pulsatile and laterally expansile. may hear bruits due to turbulent blood flow
signs of ruptured AAA
retroperitoneal haemorrhage: cullen’s sign (bruising around umbillicus), greys sign: bruising in flank/ iliac fossa
SBO
I: distension, more central. ausculation: high pitched tinkling sound= early sign, absent= late sign. bilous vomitin (early sign)
LBO:
gross distension, peripheral, high pitched tinkling bowel sounds (early sign), absent bowl sounds (late sign), faeculent vomitig (late sign)
PC: peritonitis:
diffuse abdo pain, tenderness esp on palpation, guarding, ridgidity, rebound tenderness, pt lying still
sigmoid volvulus
coffee bean sign, originates from LIF, sigmoid colon has rotated on its mesentery, causing it to become obstructed and very enlarged. high risk of perforation or bowel ischaemia (due to strangualted blood supply)
McBurney point tenderness
1/3 distance from right ASIS to umbillicus
rovsing sign
deep palpation of LLQ causes RLQ referred pain
psoas sign
RLQ pain with extension of the right leg against resistance (secondary to inflammation of a retrocaecal appendix)
cope’s obturator sign
RLQ pain with flexion and internal rotation of right leg
blumberg’s sign
rebound tenderness caused by suddenly ceasing deep palpation of RLQ
when do you use IV urogram
renal colic- radioopaque contrast medium injected into vein, radiograpg taken at intervals as the contrast medium is filtered through the kidneys.
