abdomen Flashcards
what are the lines for division into 4 quadrants?
midline & horizontal line through umbilicus
what are the planes for division into 9 regions?
subcostal plane L3
transtubercular plane L5
midclavicular line
what are the 9 regions?
R/L hypochondriac, epigastric
R/L lumbar, umbilical
R/L inguinal, suprapubic
what structures are at transpyloric plane? (9)
L1 pylorus stomach 1st part of duodenum neck of pancreas liver hilum of spleen hilum of kidneys fundus of gallbladder origin of superior mesenteric artery
describe surface anatomy of liver
right corner: 5th rib on MCL
left corner: 5th ICS on MCL
right lower corner: costal margin at MAL
how do you palpate liver?
use right hand medial border start from right inguinal region ask patient to breathe in and press against abdominal wall move up 2cm and repeat until right costal margin
how do you percuss liver?
upper border: start from 2nd ICS & move downwards - sound from resonant to dull
lower border: start from right inguinal region & move up
describe surface anatomy of gallbladder
costal margin on 9th CC
describe surface anatomy of spleen
span from rib 9 to 11
medial border: lateral border of erector spinal
lateral border: MAL
how do you palpate and percuss spleen?
medial border of right hand
start from right inguinal region
move obliquely/diagonally
to left hypochondriac region
percussion - only assess lower border
what might you hear in auscultation of spleen?
friction rub
- on left hypochondriac region
where do you get initial pain from gallbladder?
costal margin on 9th CC
where do you get referred pain from gallbladder - explain why?
right shoulder
gallbladder inflamed -> enlarged -> press against diaphragm -> right phrenic nerve root from the same place as supraclavicular nerve (C3,4) which innervates shoulder -> stimulated supraclavidular nerve -> brain confuses the location of pain
describe the surface anatomy of kidneys
9-12cm
right kidney half a vertebra lower
left kidney: hilum at transpyloric plane (L1), 4/5cm lateral to midline
upper border - 12th rib
lower border - 3/4cm above supracristal plane (L4)
ureter vertically down from hilum to iliac fossa
how do you palpate kidneys?
“balloting”
right hand behind - fingers in renal angle
left hand to anterior surface, upper quadrant
press down just below costal margin with bouncing motion + deep breath in