Abdomen, Pelvis & Perineum Flashcards
Describe and demonstrate 9 regions / 4 quadrants of the abdomen.
9 regions • Right hypochondrium • Epigastric • Left hypochondrium • Right lumbar • Umbilical • Left lumbar • Right iliac • Hypogastric • Left iliac
Divided by mid clavicular planes, subcostal plane and transtubercular plane.
4 quadrants
• Right upper quadrant: liver, diaphragm, gall bladder, right kidney, pancreas
• Left upper quadrant: stomach, spleen, left kidney, pancreas
• Right lower quadrant: small intestine
• Left lower quadrant: small intestine
Divided by sagittal and transumbilical plane
Describe and demonstrate position of subcostal plane, transpyloric plane,
transtubercular plane, supracristal plane.
- Subcostal plane - L2/3 horizontally through costal margins
- Transpyloric plane - L1 horizontally through tips of 9th costal cartilages
- Transtubercular plane - L5 horizontally through iliac tubercles
- Supracristal plane - L4, horizontally through highest points of iliac crest
Surface mark: right + left kidneys and ureters on the posterior abdominal wall.
- Medial border: 5cm from midline
- 12th rib runs diagonally across surface
- Inferior border: 3/4cm above iliac crests
- Left edge: 11th rib
- Right kidney is often lower than left
- Hilium at L1 - transpyloric plane
- Ureter: descends from the hilium to the iliac fossa
Palpate the lower poles of the kidneys through the anterior abdominal wall.
• Bimanual palpation
- left hand under kidney (posterior)
- right hand in renal/costophrenic angle (anterior)
• Sometime able to feel inferior pole of right kidney
• Balloting
Palpation of abdominal wall: superficial and deep palpation.
- Light: use finger tips
- Deep: use hand and apply steady pressure
- Palpate liver and spleen edges
- Abdominal aorta: use both hand to press down above umbilicus
Percussion of underlying organs: liver.
- Percuss from MCL to costal margin
* Should produce a dull sound (solid organ)
Auscultation of bowel sounds.
- Apply diaphragm of stethoscope to the abdominal wall
- Listen to all parts of the abdomen
- Min. 3 minutes
Map the dermatomes of the abdominal region: T8, T10 and T12.
- T8 - below xiphoid process
- T10 - umbilicus
- T12 - suprapubic region
Locate the position of the stomach on the anterior abdominal wall.
UPPER LEFT QUADRANT
• Entry to stomach (3cm left of midline at 6th CC)
• Top of stomach (MCL 5th rib), top of right section (along transpyloric plane)
• Bottom (1-2cm below L2)
Locate the position of the duodenum on the anterior abdominal wall.
BETWEEN TRANSPYLORIC AND SUPRACRISTAL PLANE
- 5cm to right along L1
- 7-10cm down to L3
- 6-8cm left along L3
- 5cm slightly up to L2
Locate the position of the appendix and caecum on the anterior abdominal wall.
- Appendix: McBurney’s point - root (1/3 of distance from ASIS to umbilicus)
- Caecum: in triangular area bounded by transtubercular line, right MCL and lateral half of right inguinal ligament
Locate the position of the ascending and descending colon on the anterior abdominal wall.
- Ascending colon - caecum to transpyloric plane
* Descending colon - transpyloric plane laterally to left MCL to transtubercular line
What are the surface markings of the liver?
- Upper border - right 5th CC, then across lower end of sternum to 5th intercostal space in left MCL (follows diaphragm)
- Oblique border - follows right costal margin past tips of 8/9th CCs to the right MAL
- Right border - joins oblique and upper border, runs along right margin of thoracic cage
Palpate and percuss the liver
- Place medial edge of right hand on abdominal surface
- Start on right inguinal region
- Ask patient to breath in and press firmly as they do that
- Work way up to right costal margin
Inferior liver border should not be palpable in a healthy individual
- Percuss starting from second right intercostal space moving down (resonant to dull)
- Percuss from right inguinal region moving up for inferior border
Surface mark the gall bladder
Intersection of right MCL and transpyloric plane
