Abdomen and Pelvis Flashcards
Identify on the skeleton bones of the abdomino-pelvic region including lumbar vertebrae, sacrum and
pelvic girdle.
Identify important bony features: ASIS, PSIS, iliac crest, pubic arch, sacral promontory, greater and
lesser sciatic notches.
Identify the joints and ligaments: pubic symphysis, sacroiliac joints.
Netters
Ligaments
- Sacrotuberous – Sacrum to ischial tuberosity
- Sacrospinous – Sacrum to ischial spine
- Iliolumbar – Ilium to L4/5
- Anterior sacroiliac – Sacrum to ilium
Describe the position of the inguinal ligament and superficial and deep inguinal rings in bony models.
- Inguinal ligament between pubic tubercle and ASIS
- Deep – midway between ASIS and pubic tubercle
- Superficial – At public tubercle
Inguinal canal
- Roof: Internal Oblique and transversus abdominis
- Anterior: External oblique aponeurosis and internal oblique
- Floor: Inguinal ligament and lacunar ligament
- Posterior: Transversalis fascia and conjoined tendon
Be able to sex male and female pelvic girdle using pelvic inlet and subpubic angle
Male
- Infrapubic angle 50-60 degrees
- Heart shaped pelvic inlet
- Taller and narrower
- Sciatic notch narrower
Female
- Infrapubic angle over 90 degrees
- Oval
- Shorter and wider
- Wider greater sciatic notch
Describe and demonstrate 9 regions / 4 quadrants of the abdomen
9 regions
- Split using the subcostal plane, transtubercular plane and the 2 MCLs
- Right hypochondrium, epigastric, left hypochondrium
- Right flank, umbilical, left flank
- Right iliac, hypogastric, left iliac
4 quadrants
- Saggital plane and transumbilical plane
- Upper right, lower right, upper left, lower left
What is present in the 9 regions of the abdomen?
RH – Liver, gall bladder, adrenal
EG – Stomach, pancreas
LH – Stomach (some), spleen, adrenal
RL – Kidney, hepatic flexure + ascending colon
U – Ileum, aorta, IVC
LL - Kidney
RI – Ovaries, ascending colon, appendix,
HG – bladder, uterus, prostate, sigmoid colon, rectum
LI – ovaries, descending colon
Describe and demonstrate position of subcostal plane, transpyloric plane, transtubercular plane,
supracristal plane
Lumbar vertebral levels: L1, L2, L4
- Subcostal 10th CC (renal veins - L2)
- Transpyloric 9th CC (level of the pyloris, hilum of kidney, splenic vein and pancreas neck - L1)
- Transtubercular plane (between iliac tubercles, level L5)
- Supracristal plane (bifurcation of abdominal aorta - level L4)
Surface locate the position of stomach, duodenum, appendix and caecum, ascending and
descending colon and urinary bladder on the anterior abdominal wall (this is not precise surface
marking).
Stomach – Cardiac orifice at T10, Pylorus at L1. MCL is midpoint.
Duodenum – L1, 1cm left of sternum. Horizontal to 1cm right of MCL. Inferior to subcristal plane at L4. Diagonally up to 1cm left of midline, inferior to pylorus.
Appendix – right iliac region
Caecum – Midpoint of line from right ASIS to upper margin of pubic symphysis.
Ascending colon – Superiorly from caecum, right colic flexure at upper right angle of intersection of subcostal and right lateral lines (half way between ASIS and midline).
Descending colon – Right colic flexure, travels vertically until level with iliac crests
Bladder – hypochondriac region
Surface mark and palpate: Liver, gall bladder and spleen on the anterior abdominal wall
Liver:
- Upper border – R5 MCL (RHS) to 5th ICS MCL (LHS) through the lower border of the sternum
- Right border – costal margin right MAL to 5th rib RHS
- Inferior border – Costal margin right MAL to R5 MCL LHS
- Palpate – Light pressure below the right anterior costal margin. Work up from right iliac
Gall bladder – transpyloric plane meets Right MCL
Spleen:
- Between R9-11, LHS, between erector spinae lateral border and MAL
- Palpate – RHS iliac. Go diagonal. Won’t be able to feel until >3x normal size. Deep palpation.
Surface mark: right and left kidneys and ureters on the posterior abdominal wall
- Superior pole – L=R11, R=R12
- Hilum – L1 (transpyloric plane), 4-5cm from midline. 5-7cm wide.
- Inferior pole – 3/4cm above iliac crest.
- Approx. 9-12cm tall
- Ureters – descend vertically from hila to PSIS
Palpate the lower poles of kidneys through the anterior abdominal wall
- Bimanual palpation.
- Left hand under kidney, right in renal costophrenic angle.
- Bring up with left hand and palpate with right
Palpation of abdominal wall: Superficial and deep palpation
Over all 9 regions. Light then deep.
Percussion of underlying organs: liver
- Percuss liver from bottom to top and carry on up to a few ribs
- Spleen percuss starting right iliac region and moving diagonally
Auscultation of bowel sounds
- All 9 quadrants using diaphragm, listen for gurgling (>1sound in 1 min)
- Renal bruits – either side of umbilicus, bell, rumbling => renal artery stenosis
- Aorta – bruits with bell above umbilicus
Demonstrate palpation of arterial pulses: 1) Abdominal aorta (in the umbilical region), 2) femoral artery (optional you will not be asked to do this in the class or in the OSPE, but you should know the landmarks where to palpate it)
Aorta – both hands to press down above umbilicus
Femoral – Abduct thigh, press deep below inguinal ligament, midway between pubic symphysis and ASIS. One hand on top of the other
Map the dermatomes of the abdominal region: T8, T10 and T12
T8 - level of the costal margin
T10 - Level of the umbilicus
T12 - Level of the suprapubic region
