Abdomen 3 (Complete) Flashcards
What anatomical plane can be used to predict the location of the kidneys?
Transpyloric plane
Which vertebral level does the transpyloric plane and hence the hila od the kidneys, lie?
L1
Which of the kidneys lies slightly superior to the other in most patients?
Left kidney lies higher than the right
N.B. Sometimes can be at the same level and is not an uncommon finding
The ureters, from the hila of the kidneys, descend almost vertically downwards into?
The iliac fossa
In anteroposterior (AP) radiographs of the lumbosacral region, the ureters lie close to which vertebral structures?
Transverse process of the lumbar vertebrae L2-L5 and the sacroiliac joint
Explain how to mark the surface markings of the kidneys and the ureters
First locate the transpyloric line on anterior abdominal wall and reference that plane on the posterior side
Mark the spine of the L1 vertebrae (spiny process thats on level of the transpyloric plane)
(ALTERNATIVELY): Can locate the T12 vertebrae which is aproximately halfway between inferior angle of the scapula and the highest point of iliac crest.
Once L1 is identified, the hilum is 4-5cm from the posterior median line
The kidney is 9-12cm long and 5-7cm broad. The inferior pole is 3-4cm above the iliac crests
The superior pole is covered by the 12th rib
The ureter is 5cm from posterior median line and travels down vertically to the posterior superior iliac spine (PSIS) [dimple on lower back)
Explain how T12 can be located in the posterior region.
T12 vertebral level is roughly half way between the inferior angle of the scapula and the highest point of the iliac crest at the scapular line
The scapular line runs along the medial border of the scapula (aka the lateral border of the erector spinae muscle)
Which portions of the kidney can be palpated through the anterior abdominal walls?
Lower pole of the kidney (just below the costal margin)
N.B. The superior portion cannot be palpated
Where does the renal angle (costophrenic angle) lie between?
Is the angle between the posterior median line and lower border of the 12th rib
Explain how to palpate and then ballot the kidney
Place palm of left hand on anterior abdominal wall and the fingers within the costophrenic angle
Right hand will be placed in the left upgger quadrant along the costal margin.
Ask patient to take deep breath and try to capture the kidney between the left and right hand.
(Enlarged kidneys are easier to palpate)
Ballot kidneys is same thing but flexing the index and middle finger of the left hand and see if it can be felt in right hand
The thoracic aorta enters the abdominal cavity and lies along which vertebra?
T12
Describe the position of the abdominal aorta as it descends and the bifurcates into the common iliac arteries
The abdominal part of the aorta descends vertically down along the midline and ends, slightly to the left, at the level of L4 vertebra (supracristal plane) where it divides into right and left to iliac arteries
Explain how to palpate the abdominal aorta
palpated above the umbilicus (L3/4 level) just left of the midline.
You will use both hands with the palm facing downwards with pads of the fingers pressing deeply into the abdominal wall. The fingers of both hands will be pointing towards the epigastrium whilst the ulnar borders (little finger side) lie parallel to the right and left costal margins
The ilium, ischium and pubis are separate bones at birth. At around which age do they start to fuse and at which age do they completely fuse together to form the pelvic bone?
Start to fuse at around 5 years of age
Completely fuse at around 18 years of age
Memorise diagram
Memorise the diagram
When given a contrast, can see the ureters
In a person with a renal stone, parts of the ureter below the stone will not be visible due to blockage. Whereas the unaffected ureter is clearly visible
N.B. Contrast is needed to see the ureters as in control film it is barely visbile
How can a intravenous urogram be used to idedntify renal stones?
When given a contrast, can see the ureters
In a person with a renal stone, parts of the ureter below the stone will not be visible due to blockage. Whereas the unaffected ureter is clearly visible
N.B. Contrast is needed to see the ureters as in control film it is barely visbile
Takes time for the contrast to reach the kidneys and be filtered
What is the normal diametre of the abdominal aorta in patients below 50 years of age? What diametre indicates an abdominal aortic aneurysm?
Normal is <2cm
If diametre is 3cm or more then it is an AAA
Image of aoritc aneursym
