Living anatomy Abdomen and Pelvis

Question 1

In which nine regions can you separate the anterior abdominal wall?

Which planes would you use to separate these regions?

Answer 1

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

Question 2

Reference : Spinal levels of important structures

Answer 2

Question 3

What are the superior borders of the liver?

Answer 3

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

Question 4

Describe the surface markings of the oblique (lower) border of the liver

Answer 4

• Follows right costal margin
• To the tip of right 9th costal cartilage
• Left 8th costal cartilage
• 5th intercostal space on the left

Question 5

What is the right border of the liver (surface marking)?

Answer 5

Right mid-axillary line costal margin

to

plane of 5th rib/costal cartilage on mid-axillary line

Question 6

What is the surface marking of the gall bladder?

Answer 6

Tranypylroric plane at the right mid-clavicular line (Tip of 9th CC)

Question 7

What are the surface markings of the spleen?

Answer 7

9,10,11 rib on right back

Lateral borders: Erector spinae and mid-axillary line

Question 8

What do you have to expose to be able to perform an abdominal examination?

Answer 8

Everything from the nipple to the pubic symphysis

Question 9

Which 4 steps are important in a physical examination

What is different in an abdominal examination?

Answer 9

1. Inspection
2. Palpation
3. Percussion
4. Ausculation

„However, in abdominal examination, auscultation is done before palpation or percussion in order to prevent the bowel sounds being disturbed by deep palpation“

Question 10

How do you feel the pulse of the abdominal aorta in a physical examination of the abdomen?

Answer 10

Question 11

How should you palpate the spleen in an abdominal physical examination?

Answer 11

Question 12

Identify the ASIS

Answer 12

Question 13

Identify the PSIS

Answer 13

Question 14

Answer 14

Question 15

Answer 15

Question 16

Identify the iliac crest

Answer 16

Question 17

What is the sub-pubic arch?

Answer 17

Different in male and female pelvis

Question 18

What is the sacral promontery?

Answer 18

Top part of sacrum

Question 19

What are the greater and lesser sciatic notches?

Answer 19

Form greater and lesse sciatic foramina with ligaments in place

Question 20

Where is the pubic symphesis?

Answer 20

Joining of the pubis

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Question 21

What is the sacroiliac joint?

Answer 21

Joining of the sacrum and ileum

Question 22

What are the differences between male and female bony pelvis?

Answer 22

1. Pelvic inlet
   
   • Male = heart spaped, small
   • Female, oval/round, big
2. Sub-pubic angle
   
   • male: steep (V shaped), <90°
   • Female wider (>100°)

Question 23

What is the The pelvic girdle?

Answer 23

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

Question 24

What can you find at vertebra level L2/L3?

Answer 24

Sub-costal plane (Rib 10)

Question 25

How can you palpate vertebra L1?

Answer 25

On the posterior body wall, the T12 vertebral level is roughly half way between the inferior angle of the scapula and the highest point of the iliac crest at the scapular line. From this landmark, L1 vertebra can be located by palpating one spine down) .

Question 26

Which plane runs at vertebra level L4?

Answer 26

Supra-cristal plane (highest point of iliac crest) ## Footnote .

Question 27

How do you palpate and auscultate the liver?

Answer 27

Question 28

Explain the ausculation of bowel sounds Why do you perform this before palpation?

Answer 28

Normally palpation is done before auscultation but in bowel sounds: ausculation before palpation because otherwise deep palpation might change the bowel sounds

Question 29

Explain the process of light and deep palpation of the abdominal wall

Answer 29

Press deeply, below the inguinal ligament and about midway between symphysis pubis and anterior superior iliac spine.

Question 30

Explain the palpation of the femoral pulse

Answer 30

Press deeply, below the inguinal ligament and about midway between symphysis pubis and anterior superior iliac spine.

Question 31

Map the dermatomes of the abdominal region: T8, T10 & T12

Answer 31

T8: around costal margin T10: umbilicus T12: around inguinal region

Question 32

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).

Answer 32

1. Lightly draw the **IVC and the aorta.** 2. Add the **coeliac axis** and the superior mesenteric artery, the renal vessels and the kidneys and adrenal glands. 3. Superimpose the G shape of the duodenum. 4. 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. 5. Draw the serpentine splenic artery from the coeliac axis along the superior border of the pancreas to the hilum of the spleen. 6. 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. 7. Draw in the ascending and descending colon, with the hepatic and splenic flexures sitting in front of the lower parts of the kidneys. 8. 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). 9. Add a few trimmings such hepatic artery, bile duct, pancreatic ducts, inferior mesenteric vein and ureters.

Question 33

Describe sites of referred pain from visceral organs

Question 34

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.

Answer 34

Question 35

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.

Answer 35

Question 36

Where does referred pain from an appendicitis spread to?

Answer 36

First: unlocalised around umbilical region, later right lower quadrant

Question 37

Where does pain from the duodenum and head of pancreas refere to?

Answer 37

to region 1 -- \>Epigastric region (midline)

Question 38

Where does referred pain from the kidney spread to?

Answer 38

In region 6

Question 39

Where can pain from the liver, gallbladder and duodenum spread to?

Answer 39

It might spread to the shoulder region when the diaphragm gets irritated

Question 40

Explain the anatmolical landmarks of the inguinal canal

Answer 40

* 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

Question 41

Identify the trans-pyloric plane

Answer 41

Plane at vertebra level L1 * T12 Halfway between inferior angle of scapula and hightest point of iliac crest * Anterior: T tip of 9th CC

Question 42

What are the surface markings of the kidney and ureters on the posterior abdominal wall?

Answer 42

1. Draw the transpyloric plane (runs over L1), anteriorl tip of 9th CC 2. Hilums are 4-5 cm from midline at tranypyloric plane 3. About 9-12 cm long, 5-7 cm broad 4. Superior ple are covered by the 12th rib, inferior pole are about 3-4 cm above the iliac crest 5. Ureters: decend almost vertically from hilum to the PSIS (5cm. from midline)

Question 43

Palpate the inferior pole of the kidneys through tha anterior abdominal wall

Answer 43

Patinet should lie flat with legs partially flexed if necessary