Group A & B cards

Question 1

THE ANTERIOR ABDOMINAL WALL: DIVIDING PLANES AND NINE REGIONS:

Locate and name the dividing planes.

Answer 1

The abdominal wall spans the anterior and lateral sides of the abdomen.

*The left and right vertical planes are vertical lines from the midpoint of the clavicles (midclavicular line), to the midpoint of inguinal ligament. (roughly corresponds with the lateral borders of the rectus abdominus muscles).

*The transpyloric line (transverse through the pylorus) is approximately level with L1 vertebrae.

*The epigastric lines follow the along the costal margin from the 7th to 10th rib, both sides.

*The subcostal plane, a transverse (horizontal) line, at the level of the inferior aspect of the 10th costal cartilage.

*The trans-tubercular plane, a horizontal line uniting the two tubercles of the iliac crest, or 5cm posterior to the Anterior Superior Iliac Spine (ASIS).

Question 2

THE ANTERIOR ABDOMINAL WALL: DIVIDING PLANES AND NINE REGIONS:

Locate and name the 9 regions.

Answer 2

The abdomen can be split into 9 abdominopelvic regions:

Right Hypochondrium, Epigastric, Left Hypochondrium, Right lateral or lumbar, umbilical, left lateral or lumbar, right inguinal or iliac, suprapubic, left inguinal or iliac.

Question 3

What are the purposes of quadrants or regions?

Answer 3

Used to describe the location of abdominal organs and the pain associated with them.

Question 4

What organs will you find in the Right Hypochondriac region
(hypo=below/ under chondriac = ribs:

Answer 4

Right portion (lobe) of liver, the gallbladder, the right kidney and parts of the small intestine.

Question 5

What organs will you find in the Epigastric region:

Answer 5

Left lobe or portion of liver, majority of the stomach, part of the pancreas, duodenum, spleen and adrenal glands.

Question 6

What organs will you find in the Left Hypochondriac region:

Answer 6

Part of the stomach, the left kidney, the spleen, pancreas and parts of the colon (or large intestine).

Question 7

What organs will you find in the Right Lumbar region:

Answer 7

Gallbladder, right kidney, part of the liver and ascending colon (a right ass!)

Question 8

What organs will you find in the Umbilical region:

Answer 8

Umbilicus, many parts of small intestine including duodenum, jejunum, and ileum, , transverse colon and bottom portions of Left and Right kidneys.

Question 9

What organs will you find in the Left Lumbar region:

Answer 9

Descending colon, left kidney, and part of spleen.

Question 10

What organs will you find in the Right inguinal or iliac region:

Answer 10

Cecum, appendix

Question 11

What organs will you find in the Suprapubic or hypogastric region:

Answer 11

Bladder and reproductive organs (uterus and ovaries or prostate), Part of sigmoid colon, anus.

Question 12

What organs will you find in the Left Inguinal or iliac region:

Answer 12

Descending colon, the sigmoid colon.

Question 13

THE ANTERIOR ABDOMINAL WALL: DIVIDING PLANES AND 4 QUADRANTS:

Locate and name the 4 quadrants

Answer 13

• The median plane, a vertical line going from the xiphisternum (xiphoid process) to the pubic symphisis.
• The trans-umbilical plane, a horizontal or transverse line level with the umbilical, or L3/L4 vertebral levels.

(these lines form the upper left and right, or lower left or right quadrants)

Question 14

THE ANTERIOR ABDOMINAL WALL: DIVIDING PLANES AND 4 QUADRANTS:

What organs will you find in the RIGHT Upper Quadrant?

Answer 14

• RIGHT UPPER ORGANS: Liver, Gallbladder, Head of Pancreas, Right adrenal gland and portion of right kidney

Question 15

THE ANTERIOR ABDOMINAL WALL: DIVIDING PLANES AND 4 QUADRANTS:

What organs will you find in the LEFT Upper Quadrant?

Answer 15

Spleen, Stomach, Body of Pancreas, Left Adrenal gland and portion of left kidney.

Question 16

THE ANTERIOR ABDOMINAL WALL: DIVIDING PLANES AND 4 QUADRANTS:

What organs will you find in the RIGHT Lower Quadrant?

Answer 16

Cecum, Ascending colon, appendix, lower pole of right kidney and right ureter.

Question 17

THE ANTERIOR ABDOMINAL WALL: DIVIDING PLANES AND 4 QUADRANTS:

What organs will you find in the LEFT Lower Quadrant?

Answer 17

Descending colon, lower pole of left kidney and left ureter.

Question 18

LOCATE THE LIVER AND NAME THE BILIARY DUCTS:

Answer 18

• Located in the right upper quadrant between rib 4 and rib 10 from the mid-axillary line on the right ipsilateral (runs from anterior to posterior) to the midclavicular line of the left side (or contralateral).
• The greater part of the right hypochondriac region, part of the epigastric region, and extended into the left hypochondriac region.

LEFT & RIGHT HEPATIC DUCTS - COMMON HEPATIC DUCT - CYSTIC DUCT- COMMON BILE DUCT
* Biliary ducts: when the liver secretes bile, it is collected by a system of ducts that flow from the liver through the right and left hepatic ducts, which drain into the common hepatic duct, which joins with the cystic duct, from the gallbladder to form the common bile duct, which runs from the liver to the duodenum: the first section of the small intestine.

• The biliary ducts have a tree-like spread, throughout the liver with the gall bladder sitting inferiorly to the right hepatic duct, situated in the right lobe of the liver.

Question 19

LOCATE THE GALLBLADDER

Answer 19

• The gall bladder is in the right upper abdominal quadrant.
• It is attached to the posterior surface of the right lobe of the liver (liver is situated in the right upper quadrant between Ribs 4-10, from the midaxillary line - right ipsilateral to the mid clavicular line contralateral (left).
• The gall bladder also contacts the superior part of the duodenum and transverse colon.

Question 20

What are the gallbladders three parts and can you describe anything about its shape or size:

Answer 20

It is pear shaped and about 7 to 10 centimetres long and 2-3 centimetres wide.

It has three parts: FUNDUS is the bottom of the gallbladder that protrudes from the liver and visible anteriorly at the tip of the 9th rib. BODY is the main dilated portion of the gallbladder that lies between the fundus and cystic duct. NECK is the narrow part that tapers into the cystic duct.

Question 21

LOCATE THE PANCREAS

Answer 21

• The pancreas lies in front of L2 in the epigastric and left hypochondriac regions of the abdominal cavity it lies transversely behind the stomach between the spleen and the duodenum. The head of the pancreas occupies the calf of the duodenum its body extends along the transparent lauric line level with vertebral vertebrae L1 on the tail lying above this line to the region in the left hypochondriac in front of the kidney.
• The pancreas is an oblong shaped organ positioned at the level of the trans pyloric plane except for the tail of the pancreas it is a retroperitoneal organ located deep within the upper abdominal in the epigastrium and left hypochondrium regions within the abdomen the pancreas has direct anatomical relations to several structures the stomach the duodenum transverse mesocolon, common bile duct and spleen.

Question 22

LOCATE THE KIDNEYS AND COSTOVERTEBRAL ANGLE

Answer 22

• The right kidney usually lies about 1 centimetre lower than the left due to the liver occupying so much space.
• There are two kidneys - each one is located from T12 to L3 and partially protected by rib 11 and rib 12.
• The right kidney has superiorly the right adrenal gland and anteriorly the right lobe of the liver.
• The left kidney has superiorly the left adrenal gland, and anteriorly the spleen, stomach and pancreas.
• The costovertebral angle is the area of the back overlying the kidney. It is an angle made by the vertebral column and rib 12 coastal margin. It is used to elicit tenderness with percussion in people with kidney infections.

Question 23

7. LOCATE THE LUNGS (ANTERIOR & POSTERIOR LANDMARKS).

Answer 23

• The lungs are located either side of the heart. The base of each lung rests on the diaphragm.
• The apex is at the level of the clavicle about 2.5 centimetres above the clavicle.
• The right lung is shorter because the diaphragm is higher to accommodate the liver.
• Both lungs descend from the apex (or point) of the lung behind the sternoclavicular joint to come together behind the sternal angle.
• They pass downwards towards the midline, until the level of the 4th coastal cartilage, where they reach the 6th coastal cartilage in the mid- clavicular line.
• The posterior border of both lungs passes vertically downwards in the front of the necks of the ribs (flattened portion of rib). Approximately 2cm either side of the spines of the vertebrae, from the apex of the lung to the level of the 10th rib.

Question 24

LOCATE THE HEART AND ITS APEX

Answer 24

The heart is a cone shaped hollow muscular organ. It is about the size of the owner’s fist.

It’s located in the central compartment of the thoracic cavity called the mediasternim between the lungs (sits inferior to 2nd rib with apex on the in left 5th intercostal space).

It is located a little more to the left than the right and rests on the central tendon of the diaphragm, which is an aperneurosis which forms the top of the dome shaped diaphragm.

It blends with the fibrous pericardium above helping to maintain its place.

The apex is the most inferior portion of the heart. It is used to evaluate cardiac size (an increase in its transverse diameter may be a sign of an enlargement of the heart – cardiomegaly).

The apex is located on the left midclavicular line at the level of the 5th intercostal space (a little below the nipple) and 9 centimetres from the midsternal line.

Question 25

LOCATE CAROTID ARTERY AND THE ARCH OF THE AORTA

Answer 25

The left common carotid artery arises from the arch the aorta (level with T4 posteriorly or 2nd rib anteriorly).

Arch of the aorta is indicated by a line from upper border of right 2nd costal cartilage to mid sternal line and arches up, backward and to the left below the manubrium at level of T4.

The right common carotid artery arises from the brachiocephalic artery. They pass on either side of the neck deep to the SCM to the level of the upper border of the thyroid cartilage (C4).

Where each divide into the internal (supplies areas inside the skull) and external carotid arteries (supplies areas outside the skull).

Question 26

LOCATE THE VERTEBRAL ARTERY

Answer 26

The vertebral arteries branch from the subclavian arteries (under clavicle) and merge to form the basilar artery in a complex called the vertebrobasilar system.

The vertebral arteries arise from the subclavian arteries, on each side of the body and then enter deep to the transverse process at the level of C6, C7.

They then proceed superiorly, in the transverse foramen of each vertebra until C1.

At level C1, the vertebral arteries travel across the posterior arch of the atlas before entering the foramen magnum (large opening or hole in the occipital bone of the skull).

In the skull, the two vertebral arteries join up to form the basilar artery, which is the main supply to the brainstem, and connects the Circle of Willis to potentially supply the rest of the brain if one of the carotids fails.

Question 27

LOCATE THE CAROTID PULSE

Answer 27

CAROTID PULSE - press just inside the medial border of a well relaxed sternocleidomastoid (SCM) muscle roughly at the level of the cricoid cartilage - a ring of cartilage that surrounds the trachea, inferior to the thyroid cartilage in the neck at the level of C6 vertebra.

Question 28

LOCATE THE BRACHIAL PULSE

Answer 28

BRACHIAL PULSE - with the pads of your index and middle fingers, press medially to the biceps brachii tendon in the bicipital tuberosity of the radius, in the antecubital fossa (or in the dip of the elbow anteriorly)

Question 29

LOCATE THE RADIAL PULSE

Answer 29

RADIAL PULSE - At the base of the patient’s thumb, with the pads of your index and middle fingers, press the distal end of the radius.

Question 30

LOCATE THE FEMORAL PULSE

Answer 30

FEMORAL PULSE (remember consent) - with the pads of the index finger and middle fingers, press deeply below the inguinal ligament (groin crease), between the anterior superior iliac spine (ASIS) and the symphysis pubis. The inguinal ligament is formed by the lower border of the neurosis of the external obliques muscle. It is a fibrous band that arises from the anterior superior iliac spine and attaches to the pubic tubercle.

Question 31

LOCATE THE DORSALIS PEDIS PULSE

Answer 31

DORSALIS PEDIS - with the pads of the index and middle fingers, feel the dorsum of the foot not the ankle, just lateral to the tendon of the extensor hallucis longus. Request the model to extend big toe to locate accurately the tendon.

Question 32

LOCATE THE POSTEIOR TIBIAL PULSE

Answer 32

POSTERIOR TIBIAL PULSE - with the pads of the index and middle fingers, curve your fingers behind and slightly below the posterior surface of the medial malleolus of the ankle, and the medial border of the calcaneal tendon.

Question 33

LOCATE THE THYROID GLAND

Answer 33

The thyroid is a butterfly-shaped endocrine gland located in the anterior neck affixed to the trachea between the C5 and T1 vertebrae.

The trachea is a large membranous tube reinforced by rings of cartilage, extending from the larynx to the bronchial tubes and conveying air to and from the lungs.

The thyroid cartilage (‘Adam’s Apple’) is in the superior portion level of C4, inferior portion level of C5.

Above the thyroid cartilage is the hyoid bone (shaped like a horse-shoe) located opposite C3. The hyoid bone is anchored by the omohyoid, sterno-hyoid, and thyrohyoid muscles, known collectively as the infrahyoid muscles which aid tongue movement and swallowing.