Abdomen and Pelvis

Question 1

At what level is the transtubercular plane?

Answer 1

L5 (horizontal line joining left and right iliac tubercles

Question 2

At what level is the subcostal plane?

Answer 2

L2/3 (horizontal line joining right and left costal margins in mid-axillary lines

Question 3

What are the 9 abdominal regions from top right across and then down (Like reading a book)?

Answer 3

Right hypochondrium, Epigastric, left hypochondriac, right lumbar/flank, umbilical, left lumbar/flank, right inguinal, suprapubic, left inguinal

Question 4

In current clinical practice, abdomen is divided into four quadrants, what the four regions?

Answer 4

Right upper quadrant, left upper quadrant

Right lower quadrant and left lower quadrant

Question 5

At what vertebral level is the xiphisternal joint?

Answer 5

T8/9

Question 6

What level is the midpoint between inferior angle of scapula and top of iliac crest?

Answer 6

T12

Question 7

What level is the transpyloric plane?

Answer 7

L1

Question 8

What level is the tip of the 9th costal cartilage?

Answer 8

L1

Question 9

What level is the sub-costal plane (rib 10)?

Answer 9

L2/L3

Question 10

What level is the umbilicus?

Answer 10

L3/4

Question 11

What level is the supra-crustal plane?

Answer 11

L4

Question 12

What level are the iliac tubercles?

Answer 12

L5

Question 13

Where is the upper border of the liver?

Answer 13

Upper border closely follows the diaphragm, the upper border (in mid respiration) is marked by a line from the right 5th rib and costal cartilage which extends across the lower end of the sternum to the left 5th intercostal space in the midclavicular line
Oblique border- Follows the right costal margin from the right mid axillary line through the tip of right 9th costal cartilage to tip of left 8th costal cartilage to left 5th intercostal space in midclavicular line
Right border- Right border starts from point 4 and ascends upwards along the right margin of the thoracic cage to meet point 1 on the 5th rib

Question 14

Where do you find the gall bladder?

Answer 14

Where transpyloric plane meets the right midclavicular line which is at tip of right 9th costal cartilage or where lateral border of rectus abdominis muscle crosses the costal margin

Question 15

Where is the spleen found?

Answer 15

Along the left 9th, 10th and 11th ribs between erector spina muscles and mid-axillary line

Question 16

What are the 4 stages of physical examination of the abdomen?

Answer 16

Inspection
Auscultation
Palpation
Percussion

Question 17

What does the inspection stage of abdomen consist of?

Answer 17

Make note of shape of abdomen, skin abnormalities, surgical scars, masses, movement of abdominal wall with respiration

Question 18

What does the auscultation stage of abdomen consist of?

Answer 18

Apply diaphragm of stethoscope to the abdominal wall firmly but with gentle pressure. Bowel sounds- listen systematically over all parts of the abdomen. Should listen for at least 3 minutes before coming to conclusion of absence

Question 19

What does the palpation stage of abdomen examination consist of?

Answer 19

Light palpation- Light palpation in each region using the fingertips. Palm of the hand moulding over the abdominal surface and the fingers flex at metacarpo-phalangeal joints
Deep palpation- place the flat of hand over abdominal wall and apply firm steady pressure. You may use both hands where upper hand is used to exert pressure while lower hand is used to feel organ or mass

Question 20

What does the percussion stage of abdomen exam consist of?

Answer 20

Percussing the abdominal wall produces a hollow, drum-like sound over air filled spaces such as stomach and colon but dull sound over solid organs- liver, spleen or over liquids

Question 21

How do you palpate the lumbar vertebrae?

Answer 21

Press down firmly in midline of abdomen with pads of fingers

Question 22

How do you measure the pulse of abdominal aorta?

Answer 22

It can be felt powerfully near lumbar vertebral bodies above the umbilicus just left of the midline

Question 23

How do you palpate the spleen?

Answer 23

The spleen is not usually palpable in a healthy subject. If it is enlarged about three times its normal size, it can be palpated below left anterior costal margin

Question 24

What does palpation of both the liver and the spleen depend on?

Answer 24

Their downward movement when the subject takes a deep breath

Question 25

How do you palpate the liver?

Answer 25

In lean subjects, by light pressure with fingertips below the right anterior costal margin. When the subject breathes in deeply you will feel displacement of fingers by anterior border of liver as diaphragm pushes it inferiorly

Question 26

How do you use percussion to define the extent of the liver?

Answer 26

Percuss from mid-clavicular line to costal margin. This will define upper and lower borders.

Question 27

How would you mark hilum/medial border of kidneys?

Answer 27

4-5 cm from posterior median line

Question 28

How big is the kidney in most adults?

Answer 28

9-12 cm long and 5-7cm broad

Question 29

What covers the superior pole of the kidneys?

Answer 29

They are covered posteriorly by 12th ribs

Question 30

Where are the inferior poles of the kidneys?

Answer 30

3-4 cm above iliac crests

Question 31

Where are the ureters?

Answer 31

They descend almost vertically form hila into iliac fossae

Question 32

How should a patient lie if they’re going to have their kidneys palpated?

Answer 32

Flat on a couch with knees and hips semi flexed to relax abdominal wall muscles

Question 33

What are the two ways of palpating the kidneys?

Answer 33

Bimanual palpation- Use both hands. Keep left hand underneath subject’s flank with palm facing upward and the fingers in the renal angle. Use your right hand to palpate the kidney through the anterior abdominal wall in upper quadrant. Press down deeply just below the costal margin. Ask patient to breath in deeply whilst you try to catch kidney between two hands
Balloting- Ballot the kidney by flexing the index and middle fingers of the left hand at the metacarpophalangeal joints in the renal angle so that the kidney is pushed anteriorly and strikes the right hand