Abdomen Flashcards
what organs can be found in the R upper quadrant?
- right lobe of liver
- pancreatic head
- R kidney
- upper part of asc colon
- first part of transverse colon
- gall bladder
- right adrenal gland
- duodenum
what organs can be found in the L upper quadrant?
- left lobe of liver
- left kidney
- stomach
- pancreatic body and tail
- left adrenal gland
- spleen
- final part of transverse colon
- upper part of descending colon
what organs can be found in the R lower quadrant?
- appendix
- caecum
- right ovary and fallopian tube
- right vas deferens
- nerves and vessels of R testis
- lower part of ascending colon
- bladder (if very full)
what organs can be found in the L lower quadrant?
- sigmoid colon
- lower part of descending colon
- left ovary and fallopian tube
- nerves and vessels of left testis
- left vas deferens
how do you divide the abdomen into 9 regions with horizontal lines?
- subcostal plane (L3)
- Transtubercular plane (L5)
how do you find the transtubercular plane?
- line passing through iliac tubercles
- illiac tubercles: can be palpated posteriorly to ASIS
what divides the abdomen into 9 regions vertically?
2 MCL on either side
what are the 3 regions on the top row?
- R hypochondriac
- epigastric
- left hypochondriac
what are the 3 regions on the middle row?
- R lumbar
- umbilical
- L lumbar
What are the 3 regions on the bottom row?
- R inguinal
- Suprapubic (hypogastic)
- L inguinal
what is in the R hypochondriac?
- SI
- R kidney
- gall bladder
- hepatic flexure of colon
- liver
what is in epigastric?
- adrenal glands
- spleen
- pancreas
- duodenum
- stomach
- liver
What is in the L hypochondriac?
- pancreas
- L kidney
- splenic flexure of colon
- spleen
What is in the R lumbar?
- ascending colon
- liver
- gall bladder
What is in the umbilical region?
- duodenum
- ileum
- jejunum
- umbilicus
what is in the L Lumbar region?
- descending colon
- left kidney
what can be found in the R inguinal region?
- cecum
- appendix
what can be found in the suprapubic region?
- female reproductive organs
- sigmoid colon
- urinary bladder
what can be found be in the L inguinal region?
- descending colon
- sigmoid colon
what structures are present at the transpyloric plane?
- pylorus of stomach
- 1st part of duodenum
- L1
- origin of SMA
- hilum of spleen
- liver
- fundus of gallbladder
- neck of pancreas
- hila of kidneys
what acronym can be used to remember the things at the transpyloric plane?
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G = gall bladder, L= liver, P = pylorus, D = duodenum, P = pancreas, k = kidneys, S = spleen
where are the corners of the liver?
upper right: 5th rib on MCL
upper left: 5th ICS
lower right: costal margin at MAL
where is the gall bladder located?
inferior border of liver
where rectus abdominis meets costal margin on 9th CC
where is the spleen located?
L hypochondriac region
ribs 9-11
lateral margin = level of MAL
medial margin = lateral border of erector spinae
what is important to remember before doing an abdo exam?
ask if in pain
how do you palpate liver?
start at iliac crest, move up to costal margin
breathe in and out (liver is pushed down with each inhalation)
light palpation first, then deep
how do you palpate the gall bladder?
palpate in diagonal direction with same technique
how do you auscultate the abdomen?
pick 2 places would listen for 3 mins ideally but listen for 30 normal = presence of bowel sounds abnormal = no bowel sounds heard always tap on diaphragm before use
how do you percuss the liver?
start at superior border = start at 2nd right ICS, work way down until you hear the sound change from resonant to dull
inferior border = same thing but start from R inguinal region up
in what direction do you percuss the liver?
start from R inguina, region and advance towards L hypochondriac
what could cause an enlarged spleen?
- liver disease
- infection e.g. bacterial endocarditis
- inflammation e.g. Rheumatoid arthritis
- sickle cell, HA
what could R upper quadrant pain indicate?
- gallbladder disease
- think gallbladder and liver
why can gallbladder pain refer to R shoulder?
gallbladder inflamed –> enlarged, might push on diaphragm = irritation
sends a signal through R phrenic nerve, which arises from same place in spinal cord as supraclavicular nerve
supraclavicular nerve innervated shoulder
brain gets confused
what are the surface landmarks of the kidneys?
- 9-12cm long
- Left slightly higher (R side has liver)
- hilum = at transpyloric plane (L1) 4-5cm lateral to posterior midline
- superior pole of L is at rib 10, R is half a vertebrae below
- inferior pole of L is 4cm above supracristal plane (L4)
how do you palpate the kidneys?
- balloting
- place one hand underneath patients flank with palm facing up, fingers in renal angle
- other hand to palpate ant abdo wall by pressing just below costal margin
- ask pt to take a deep breath, try and capture kidney
where is a lumbar puncture carried out in adults/children?
adults - between L3/4
children - L4/5
find supracristal plane and move up 1 vertebrae
label bony landmarks of pelvis
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what are the differences between male and female pelvic bones?
- ilium: males more narrow, women broad
- pelvic inlet shape: males narrower/heart shaped, females wider/oval shaped
- pubic arch (b/ 2 inferior pubic rami): males = 70 degrees, female = 90-100
- sacrum: males longer/narrow, females shorter/wider
what are hernias?
protrusions of abdominal contents through a weak spot in muscle layer of abdo wall
what is the difference b/ direct and indirect inguinal hernias?
direct: arises directly through inguinal nerve
indirect: arises through inguinal ring and through canal
what are the 2 inguinal rings and what do they maark?
- deep and superficial
- beginning and end of inguinal canal
what is the location of the deep ring?
located just superiorly to inguinal ligament (midway between ASIS and pubic symphysis)
what is the location of the superficial ring?
medial to deep
in medial 1/3 of distance between ASIS and pubic symphysis
superficial to inguinal ligament
what does the inguinal canal contain?
ilio-inguinal nerve
genital branch of genitofemoral nerve
spermatic cord
round ligament of uterus
what is the route of semen in ejaculation?
SEVEnUP S: seminiferous tubules of testes E: epididymis V: vas deferens E: ejaculatory duct
describe the route of urine in micturition in males
overlaps with seminal route
urine from ureters collects in bladder
travels through urethra to penis
describe the route of a fertilised oocyte
egg created in ovaries
released into fallopian tubes
fertilised by sperm if present
travels to uterus where it implants itself and remains until birth
what is the route of micturition in females
doesnt overlap with any reproductive procedures
ureters transport urine into bladder
urine exits through urethra
why are females more susceptible to UTIs?
- male urethra longer than female
length between external bacteria and bladder short –> harder for body to fight infections - opening of urethra in females is closer to anus –> easier for pathogens to travel up
