Surface marking and palpation of abdominal organs

Question 1

What are the surface markings of the stomach?

Answer 1

LUQ, spans in epigastric+ left hypochondrium regions.

Pylorus lies at transpyloric plane L1, just right of the midline

Question 2

What are the surface markings of the duodenum?

Answer 2

Superior part (L1): in transpyloric plane

Descending part (L1-3): curves inferiorly, just right of the midline.

Inferior part (L3): travels to left of the midline, just above umbilicus

Ascending part (L2): Ascends + curves anteriorly

Question 3

What are the surface markings of the appendix?

Answer 3

2.5 cm medial to ASIS in MCL.

Question 4

What are the surface markings of the caecum?

Answer 4

Right iliac region above lateral half of inguinal ligament

Question 5

What are the surface markings of the ascending and descending colon?

Answer 5

Ascending: starts from caecum in right iliac region, travels up the right flank along MCL + into the right hypochondrium until it reaches the transpyloric plane

Descending: Starts from splenic flexure on lef, travels down towards left iliac, then turns posteriorly

Question 6

What are the surface markings of the urinary bladder?

Answer 6

Hypogastric region

Apex of bladder is directed towards the top of the pubic symphysis

Question 7

What are the surface markings of the liver?

Answer 7

Upper border: Subdiaphragmatic, Left 5th ICS MCL to right MAL

Lower border: oblique line from left 5th ICS MCL through 9th CC to costal margin on right

Right border: right MAL. Curved line between upper + lower border

Question 8

How would you palpate the liver?

Answer 8

Subject to lie flat

Place hand on abdomen, lateral to rectus abdominus on the right

In lean subjects: light pressure with the fingertips below right anterior costal margin. Subject breathes in deeply, fingers are displaced by the anterior border of the liver as the diaphragm pushes it inferiorly.

Question 9

What are the surface markings of the gall bladder? How would you palpate the gall bladder? (Not normally palpable)

Answer 9

Where transpyloric plane meets right MCL (at tip of the right 9th CC) Projects slightly below right costal margin.

Roll patient 45 degrees to left + ask to take a deep breath.

Question 10

What are the surface markings of the spleen?

Answer 10

Left side of the posterior abdominal wall, posterior to CC of ribs 9-11. Long axis along ribs 9-11 on MAL + extends medially to the lateral border of erector spinae.

Question 11

How would you palpate the spleen on the anterior abdominal wall?

Answer 11

Spleen not usually palpable in a healthy subject.

If enlarged, ~ 3X its normal size, it can be palpated below the left anterior costal margin.

Question 12

What are the surface markings of the kidneys?

Answer 12

Transpyloric plane may be extended from anterior abdominal wall to posterior, through L1 vertebra. = Hilum of each kidney (~4cm from midline)

Left kidney may be slightly higher (liver pushes right down)

~ 9-12cm long + 5-7cm broad.

Superior poles covered posteriorly by 12th ribs.

Inferior poles ~ 3-4cm above iliac crests.

Question 13

What are the surface markings of the ureters?

Answer 13

Descend vertically from hila to iliac fossa (PSIS)

1.5 cm lateral to midline

Question 14

How would you palpate the lower poles of the kidneys?

Answer 14

On the anterior abdominal wall.

Patient supine with knees + hips semi-flexed to relax abdominal wall muscles.

Left hand under flank with palm facing up + fingers in the costophrenic angle.

Right hand to palpate the kidney through the anterior upper quadrant. Press deeply just below the costal margin.

Patient to take a deep breath whilst you capture the kidney between the 2 hands.

Question 15

Demonstrate superficial palpation of the abdominal wall

Answer 15

Light palpation in each region using finger tips.

Palm of the hand moulding over the abdominal surface + fingers flexing at metacarpo-phalangeal joints.

Question 16

Demonstrate deep palpation of the abdominal wall

Answer 16

Place flat of hand over the abdominal wall + apply firm steady pressure.

Can use both hands where upper hand is used to exert pressure, while lower hand feels for the organ or mass.

Question 17

Demonstrate percussion of the liver

Answer 17

Percuss from the MCL to the costal margin. This will define the upper + lower borders of the liver

Expect dull sound over organ.

Question 18

Demonstrate auscultation of bowel sounds

Answer 18

Listen systematically over all parts of the abdomen.

Listen for at least 3 minutes before coming to any conclusion of absence of bowel sounds.

Apply diaphragm of stethoscope to abdominal wall firmly but with gentle pressure.