Living anatomy Abdomen and Pelvis Flashcards
In which nine regions can you separate the anterior abdominal wall?
Which planes would you use to separate these regions?
Horizontal planes
- Sub-costal plane (horizontal line joining the right and left costal margin at mid-axillary line
- Transtubercular plane (line joining the right and left iliac tubercles)
Vertical Planes
- Right and left from mid clavicular to mid-inguinal points
Reference : Spinal levels of important structures
What are the superior borders of the liver?
Closely follows diaphragm
Line over
- Right 5th rib and costal cartilage
- Extends over lowe end of sternum
- to the left 5th intercostal space, midclarvicular line
Describe the surface markings of the oblique (lower) border of the liver
- Follows right costal margin
- To the tip of right 9th costal cartilage
- Left 8th costal cartilage
- 5th intercostal space on the left
What is the right border of the liver (surface marking)?
Right mid-axillary line costal margin
to
plane of 5th rib/costal cartilage on mid-axillary line
What is the surface marking of the gall bladder?
Tranypylroric plane at the right mid-clavicular line (Tip of 9th CC)
What are the surface markings of the spleen?
9,10,11 rib on right back
Lateral borders: Erector spinae and mid-axillary line
What do you have to expose to be able to perform an abdominal examination?
Everything from the nipple to the pubic symphysis
Which 4 steps are important in a physical examination
What is different in an abdominal examination?
- Inspection
- Palpation
- Percussion
- Ausculation
„However, in abdominal examination, auscultation is done before palpation or percussion in order to prevent the bowel sounds being disturbed by deep palpation“
How do you feel the pulse of the abdominal aorta in a physical examination of the abdomen?
How should you palpate the spleen in an abdominal physical examination?
Identify the ASIS
Identify the PSIS
Identify the iliac crest
What is the sub-pubic arch?
Different in male and female pelvis
What is the sacral promontery?
Top part of sacrum
What are the greater and lesser sciatic notches?
Form greater and lesse sciatic foramina with ligaments in place
Where is the pubic symphesis?
Joining of the pubis
–>
What is the sacroiliac joint?
Joining of the sacrum and ileum
What are the differences between male and female bony pelvis?
- Pelvic inlet
- Male = heart spaped, small
- Female, oval/round, big
- Sub-pubic angle
- male: steep (V shaped), <90°
- Female wider (>100°)
What is the The pelvic girdle?
The pelvic girdle is composed of the appendicular hip bones (ilium, ischium, and pubis) oriented in a ring, and connects the pelvic region of the spine to the lower limbs
Which plane runs at vertebra level L4?
Supra-cristal plane (highest point of iliac crest)
.
How do you palpate and auscultate the liver?
Explain the ausculation of bowel sounds
Why do you perform this before palpation?
Normally palpation is done before auscultation but in bowel sounds: ausculation before palpation because otherwise deep palpation might change the bowel sounds
Explain the process of light and deep palpation of the abdominal wall
Press deeply, below the inguinal ligament and about midway between symphysis pubis and anterior superior iliac spine.
Explain the palpation of the femoral pulse
Press deeply, below the inguinal ligament and about midway between symphysis pubis and anterior superior iliac spine.
Map the dermatomes of the abdominal region: T8, T10 & T12
T8: around costal margin
T10: umbilicus
T12: around inguinal region
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).
- Lightly draw the IVC and the aorta.
- Add the coeliac axis and the superior mesenteric artery, the renal vessels and the kidneys and adrenal glands.
- Superimpose the G shape of the duodenum.
- Draw the head and uncinate process of the pancreas wrapped round the superior mesenteric artery, with the neck and body of the pancreas passing across and up to the hilum of the left kidney, and the tail with the spleen attached.
- Draw the serpentine splenic artery from the coeliac axis along the superior border of the pancreas to the hilum of the spleen.
- Draw the superior mesenteric vein alongside the artery and the portal vein emerging from behind the 1st part of the duodenum to enter the lesser omentum. Use broken lines to represent the splenic vein and the connections posterior to the pancreas.
- Draw in the ascending and descending colon, with the hepatic and splenic flexures sitting in front of the lower parts of the kidneys.
- Draw the cut edges of peritoneum to mark the root of the transverse mesocolon and The Mesentery (i.e. the mesentery of the jejunum and ileum).
- Add a few trimmings such
hepatic artery, bile duct, pancreatic ducts, inferior mesenteric vein and ureters.
Identify on the model: Urinary bladder, ureter, urethra, prostate gland, seminal vesicle, ductus deferens, spermatic cord, testis, body of penis, corpus spongiosum, corpus cavernosum, rectum, anal canal and external anal sphincter.
Identify on the model: Ovary, uterine tube, body of uterus, cervix, external & internal os, vaginal walls & canal, vaginal fornices, urinary bladder, urethra, rectouterine pouch, vesico-uterine pouch, round ligament, broad ligament, clitoris, labium majus & minus, rectum, anal canal & external anal sphincter.
Where does referred pain from the kidney spread to?
In region 6
Where can pain from the liver, gallbladder and duodenum spread to?
It might spread to the shoulder region when the diaphragm gets irritated
Explain the anatmolical landmarks of the inguinal canal
- Inguinal ligament–> between ASIS and pubic tubercle
- Superficial ring: apneurosis of external oblique muscle, ring is just superior to pubic tubercle
- Deep ring= about 1 cm lateral from mid point of inguinal ligament
Identify the trans-pyloric plane
Plane at vertebra level L1
- T12 Halfway between inferior angle of scapula and hightest point of iliac crest
- Anterior: T tip of 9th CC
What are the surface markings of the kidney and ureters on the posterior abdominal wall?
- Draw the transpyloric plane (runs over L1), anteriorl tip of 9th CC
- Hilums are 4-5 cm from midline at tranypyloric plane
- About 9-12 cm long, 5-7 cm broad
- Superior ple are covered by the 12th rib, inferior pole are about 3-4 cm above the iliac crest
- Ureters: decend almost vertically from hilum to the PSIS (5cm. from midline)
Palpate the inferior pole of the kidneys through tha anterior abdominal wall
Patinet should lie flat with legs partially flexed if necessary
