abdomen Flashcards
abdomen report
abdomen soft, non-tender
no tenderness, guarding, rigidity or masses
how might palpation of the abdomen be facilitated
ask patient to flex the hip and knee joints to relax the anterior abdominal wall muscles
what pathology means you can feel the liver
hepatomegaly - liver disease (cirrhosis)
inflamed gallbladder - eg cholecystitis
liver and gallbladder palpation report
surface -> smooth/irregular, soft/hard
any tenderness or pulsations
which poles of the kidney are palpable
lower poles of kidney are palpable
upper poles of kidney not palpable (inaccessible behind ribs)
what pathology means you can feel kidneys
bilaterally enlarged - polycystic kidney disease or amyloidosis
unilaterally enlarged - renal tumour
not pathology but also if low BMI
palpating abdominal aortic pulse pathology
abdominal aortic aneurysm - pulsatile expansile mass, pushes up against your fingers, hands move outwards
what is the distance between the upper and lower limits of the liver in a healthy adult
~13cm
why do we percuss for shifting dullness
to examine for ascites = fluid in the peritoneal cavity, classically due to liver cirrhosis (other causes are liver cancers and heart failure)
how would you describe bowel sounds
normal BS -> heard immediately as gurgling, clicks -> report as bowel sounds present
reduced or absent -> may be pathological eg paralytic ileum or peritonitis
high pitch (tinkling) infrequent BS (borborygmi) -> may indicate intestinal obstruction = emergency
abdominal planes and their vertebral levels
L1 - transpyloric plane, pylorus of stomach
L3 - subcostal plane, lower end of 10th costal cartilage
L3/4 - umbilicus
L4 - supracristal plane, highest point on iliac crest
L5 - inter tubercular plane, iliac tubercles
S2 - ASIS line, ASIS
surface markings of liver and gallbladder
LIVER
upper border - right 5th rib at MCL to left ICS at MCL
oblique border - left 5th ICS at MCL to right costal cartilage at MAL (through tip of 8th and 9th right costal cartilage)
right border - right costal cartilage at MAL to right 5th rib at MCL
GALLBLADDER
at level of right 9th costal cartilage where MCL and transpyloric plane meet
surface markings of spleen
posterior abdominal wall
9th -11th rib between left MAL and lateral margin of erector spinae
surface markings of kidneys
posterior abdominal wall
hilum of kidney is level of L1 (transpyloric plane), 4-5cm from the posterior median line
right kidney is 2-3cm lower than left
3-4cm from lower pole to L4 (supracristal plane)
costophrenic (renal) angle position
between the posterior median line and the lower border of the 12th rib
ureters position
descend almost vertically from hilum into bladder
5cm lateral to posterior medical line at L1 to PSIS
surface marking of abdominal aorta
starts T8/9 - xiphisternal joint
bifurcates at L4 - supracristal plane into common iliac arteries
biFOURcations
carotid bifurcates at C4
trachea bifurcates at T4
iliac bifurcates at L4
McBurney’s point and appendicitis
MP - 2/3 the distance from umbilicus to right ASIS, tenderness maximal in acute appendicitis
appendicitis - starts in epigastric region, then radiates to MP
referred pain
forget - pain localises to epigastric region
midgut - pain localises to periumbilical area
hindgut - pain localises to suprapubic area
