Abdomen and Pelvis Flashcards
What’re the bony features of the pelvic girdle (6+1)
ASIS, PSIS, iliac crest, pubic arch, sacral promontory, greater & lesser sciatic notches
What’re the two joints and ligaments you need to know for this section
Pubic symphysis and sacroiliac joints
Describe the position of the inguinal ligament
is the lower border of the external oblique muscle, between the ASIS and the pubic tubercle – separates the anterior abdominal wall from the thigh
Describe the position of the superficial inguinal rings
The superficial inguinal ring is the end of the inguinal canal and is superior and lateral to the pubic tubercle
Describe the position deep inguinal ring
is the beginning of the inguinal canal and is at a point midway between the ASIS and the pubic symphysis
What vessels and structures pass deep to the inguinal ligament
Femoral nerve, artery and vein
What passes through the inguinal canal
Round ligament in females, spermatic cord in males, and vessels and lymphatics, and the ilioinguinal nerve
What’re the 9 regions
LR hypochondrion, epigastric
LR lumbar, umbilical
LR inguinal, suprapubic
What divides into the 9 quadrants
Mid clavicular planes, sub-costal plane and transtubercular plane
What vertebral level is the subcostal plane
L2/3
What vertebral level is the transpyloric plane
halfway between jugular notch of manubrium and pubic symphysis OR where you can start to see the abs at the 9th rib, L1
What vertebral level is the transtubercular plane
connecting the two iliac crest tubercles, L5
What vertebral level is the supracristal plane
Highest point of the iliac crest, L4
What is the significance of the level L1
Transpyloric plane/tip of 9th CC
What is the significance of the level L2/3
Sub-costal plane
What is the significance of the level L4
Supra-cristal plane
What vertebral level is the umbilicus
L4/5
What vertebral level is the midpoint between inferior angle of scapula and top of iliac crest
T12
What vertebral level is the Xiphisternal joint
T8/9
What vertebral level is the Sub-costal plane (rib 10)
L2/3
What vertebral level is the Mid-point of sacroiliac joint
S2
What vertebral level is the ASIS/PSIS/Sacral dimple
S2
Where does the pylorus of the stomach lie
Lies at the transpyloric plane, L1 (2.5cm left the midline). Left hypochondriac and epigastric
Describe the duodenum
GOES AROUND UMBILICUS
1st part of the duodenum – lies at the transypyloric plane. 2nd part runs downwards to reach the subcostal plane (5cm lateral to midline). 3rd part, crosses midline just above umbilicus. Ends just to left of midline at L2/3 level. 4th part at level of L2 (2.5cm left of midline).
Where are the appendix and caecum found
Umbilical region.
Appendix, caecum – Right iliac and hypogastric regions. Caecum in right iliac fossa – close to inguinal ligament. Appendix – McBurney’s point (1/3rd between ASIS and umbilicus)
Where is the ascending colon
Right lumbar
Where is the descending colon
Left lumbar
Where is the urinary bladder
Hypogastric region
Describe the surface anatomy of the liver
Upper border – follows diaphragm – line runs from right 5th rib, across lower end of the sternum, to left 5th ICS in mid-clavicular line.
Oblique border – follows right costal margin from right mid-axillary line through tip of right 9th costal cartilage to tip of left 8th costal cartilage and then to left 5th ICS in mid-clavicular line.
Right border – runs from the right costal margin in the right mid-axillary line, ascends upwards along right margin of thoracic cage to the right 5th rib.
Describe palpation of the liver
light pressure with finger tips below right anterior costal margin. Subject breathes in deeply, fingers are displaced by the anterior border of the liver as the diaphragm pushes it inferiorly
Describe the surface anatomy of the gall bladder
where transpyloric plane meets right mid-clavicular line (at tip of right 9th costal cartilage). Palpable if enlarged – below right costal margin in mid-clavicular line. Moves down on inspiration. More visible/palpable if patient rolled 45 degrees to the left.
Describe the surface anatomy of the spleen
lies along 9th, 10th, 11th ribs between erector spinae muscles and mid-axillary line.
Describe the surface anatomy of the kidney and ureters
Transpyloric plane is roughly the hilum, 4-5 cm from the midline. Right kidney is pushed down by liver. The superior poles are covered posteriorly by the 12th ribs. The inferior poles are 3-4 cm above the iliac crests. Ureters descend vertically from the hila.
Palpate the lower poles of kidneys through the anterior abdominal wall
Use right hand to palpate kidney through anterior abdominal wall in upper quadrant. Press down deeply just below costal margin – ask subject to take deep breath and try to capture kidney between 2 hands
Describe light and deep palpation
Light – using the finger tips. Each of the 9 regions.
Deep – flat of the hand rolling, firm steady pressure
Where do you percuss the liver
Percuss upwards from the right iliac fossa to the right costal margin
Describe listening to bowel sounds
Listen systematically over all parts of the abdomen – for at least 3 mins before coming to conclusion of an absence.
Describe palpation of the abdominal aorta
felt pulsing near the lumbar vertebral bodies above the umbilicus just left of midline
Map dermatomes T8, 10 and 12
T8 above umbilicus
T10 umbilicus
T12 below umbilicus
Where is pain from the foregut referred to
T5-9 dermatomes, epigastric
Where is pain from the midgut referred to
Umbilical
Where is pain from the hindgut referred to
Pubic region
Where is pain from the gallbladder/pancreas referred to
Shouldertip
Where is pain from the appendix referred to
T10/umbilical dermatome, localises when the peritoneum is inflamed to 1/3rd between ASIS and umbilicus
Look up seminal vesicle male
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Look up prostate gland male
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Look up ductus deferens male
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Look up spermatic cord male
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Look up uterine tube
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Look up body of uterus
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Look up cervix
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Look up external and internal os
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Look up vaginal fornices
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Look up rectouterine pouch
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Look up vesicouterine pouch
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Look up round ligament
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Look up broad ligament
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