Abdomen Flashcards
Where is the trans tubercular plane?
L5. Horizontal line joining left and right iliac tubercles.
Where is the subcostal plane?
L2/L3. Horizontal line joining right and left costal margins in mid axillary lines.
Where is the transpyloric plane?
L1. Tips of the 9th CCs
How to separate the abdomen into 4 regions?
Vertical line from xiphisternum to PS. Transumbilical plane.
At what level is the umbilicus?
L3/4
At what level is the xiphisternal joint?
T8/9
At what level is the tip of the 9th CC?
L1
At what level is the supracristal plane?
L4
At what level are the iliac tubercles?
L5
At what level are ASIS & PSIS/sacral dimples?
S2
At what level is the midpoint of the sacroiliac joint?
S2
Sternal angle/manubriosternal joint?
T4/5
Where is the gall bladder located?
Where the transpyloric line meets the right MCL. Tip of the right 9th CC, or where lateral border of rectus abdominis crosses costal margin.
Where is the spleen located?
Lt side, 9,10,11 ribs between erector spinae muscles and MAL
How to divide abdomen into 9 regions?
Transpyloric plane, Transtubercular plane (L5), MCLs
What structures lie at L1 (transpyloric plane)?
Hilum of kidneys, 1st part of duodenum, origin of SMA, splenic vein, neck of pancreas
Upper border of the liver?
Midrespiration: Rt 5th rib and CC across sternum to 5th ICS MCL LHS.
Oblique border of the liver?
5th ICS LHS through tips of 8/9th CC, to Rt MAL
Right border of liver?
Joins upper and oblique border, ascending upwards across Rt margin of thoracic cage.
What are the liver landmarks?
3 borders. Upper, oblique (lower) and right.
Inguinal ligament?
ASIS to Pubic tubercle
Spleen landmarks?
Lt side. Surface mark 10th rib. Palpate from costal margin at MAL for reference. Border = between erector spinae muscle and between MAL.
Describe the kidneys.
5cm from lumbar vertebrae. Lt kidney is higher at 11th rib, rt kidney is at 12th rib. Hilum is at transpyloric plane (L1). Covered posteriorly, inferior pole is 3-4cm above iliac crest.
Hepatic and splenic flexures are in front of the lower part of the kidneys?
Correct. Anterior to the inferior part of the kidneys.
Hepatic and splenic flexures are in front of the lower part of the kidneys?
Correct. Anterior to the inferior part of the kidneys.
Hepatic and splenic flexures are in front of the lower part of the kidneys?
Correct. Anterior to the inferior part of the kidneys.
Kidney palpation
Lie flat. Use both hands.
McBurneys point?
Is the root of appendix. Line from Rt ASIS to Umbilicus. Lateral 1/3rd.
Sacrotuberous ligament?
From ischial tuberosity to sacrum
Sacrospinous ligament?
Ischial spine to sacrum
Iliolumbar ligament?
From ileum to L4/5
Anterior sacroiliac?
Sacrum to ileum
Inguinal ligament?
Between pubic tubercle and ASIS
Deep inguinal ring?
Midway between ASIS and pubic tubercle
Superficial inguinal ring?
At pubic tubercle
Mid inguinal point?
Point between ASIS and pubic symphysis
Walls of the inguinal canal?
Roof = arching fibres of TA and IO. Anterior = aponeurosis of EO and IO. Post = transversals fascia. Floor = inguinal ligament
How to distinguish a male and female pelvic girdle?
Males have a heart shaped pelvic inlet, females round. Males have a smaller infrapubic angle (less than 90). Females have a greater infrapubic angle (over 100. Sacrum of females is triangular and shorter.
Things in the RH?
Liver, gall bladder, adrenal glands
EG?
Stomach, pancreas
LH
Some of stomach, spleen, adrenal
RL
Kidney, hepatic flexure and ascending colon
Um
Ileum, abdominal aorta, IVC
LL
Kidney
RI
Ovaries, ascending colon, appendix
HG
Bladder, uterus, prostate, sigmoid colon, rectum
LI
Ovaries, descending colon
Structures at subcostal plane?
L2, renal veins. Found at tips of 10th ribs of CC
What occurs at the supracristal plane?
Bifurcation of the abdominal aorta
How to identify supracristal plane?
Top of iliac crest = L4
How to identify trans tubercular plane?
Level of iliac tubercles (L5)
What can renal bruits indicate?
Renal artery stenosis
How to palpate femoral ligament?
Abduct thigh, press deep below inguinal ligament.
T8 dermatome?
approx CC9-10 (3cm above umbilicus)
T10 dermatome?
At umbilicus
T12 dermatome?
Bottom of abdomen (suprapubic region)
Heart referred pain?
Left side of chest, neck, medial left arm and forearm
Lungs diaphragm referred pain?
Neck
Oesophageal pain?
Centre of thorax, left upper chest
Liver and gall bladder referred pain?
Right shoulder and back
Stomach referred pain?
Central chest (xiphisternum) and between scapulae
Pancreas referred pain?
Centre of chest at xiphisternum level
Kidney referred pain?
waist, abdomen down to legs
Small intestine referred pain?
Umbilical
GB referred pain?
RH and RL
Appendix referred pain?
Umbilical then RI, better with pressure
Ovary pain?
Hypochondriac regions
Colon pain?
Hypogastric
Bladder pain
Back of thighs and hypogastric
Kidney and ureter surface mark
- Transpyloric plane - hilum 4/5cm lateral to midline.
- Kidney = 9-12cm and 5-7cm wide
- Superior poles covered by 12th rib
- Inferior poles 3-4cm above iliac crest
- Ureters decend vertically, close to TV process of Lv.
How to find T12?
Midpoint between inferior scapular angle and iliac crest.
Pain in the Epigastric region =?
Stomach, proximal duodenum, liver, pancreas, gb
Pain in umbilical?
Splenic flexure / proximal duodenum / appendix
Pain in suprapubic region?
Descending colon to anal canal