Surface marking and palpation of abdominal organs Flashcards
What are the surface markings of the stomach?
The stomach is in the left upper quadrant of the abdomen, and in the epigastric, umbilical, and left hypochondrium regions.
What are the surface markings of the duodenum?
Above the level of the umbilicus. The beginning and upper limit of the end of the duodenum is at L1 in the transpyloric plane, which cuts transversely through the body midway between the jugular notch and pubic symphysis, through the ends of the 9th costal cartilages. The inferior part of the duodenum is at L3. The descending part is just right of the midline. The ascending part to the left of the midline passes to the upper border of L2.
What are the surface markings of the appendix?
The junction between the lateral and middle 1/3 of a line from the ASIS to the umbilicus is the surface projection of the base of the appendix.
This is McBurney’s point, near where the intertubercular line and the right mid-clavicular line cross,.
What are the surface markings of the caecum?
The caecum is located in the triangular area bounded by the intertubercular line and lateral half of the right inguinal ligament and the inferior part of midclavicular line
What are the surface markings of the ascending and descending colon?
The ascending colon travels up the right flank and into the right hypochondrium.
The descending colon travels down the left flank into the left groin. The end of the descending colon is in the left lower quadrant.
What are the surface markings of the urinary bladder?
The apex of the bladder is directed towards the top of the pubic symphysis
What are the surface markings of the liver?
The upper border closely follows the diaphragm. In mid-respiration, it is marked by a line from the right 5th rib and costal cartilage which extends across the lower end of the sternum to the left 5th intercostal space in the midclavicular line.
The oblique (lower) border follows the right costal margin from the right midaxillary line through the tip of right 9th costal cartilage to the tip of left 8th costal cartilage to the left 5th intercostal space in the midclavicular line.
The right border starts from the right costal margin at the right midaxillary line, and ascends upwards along the right margin of the thoracic cage to meet the right 5th rib and costal cartilage.
How would you palpate the liver?
The liver occupies most of the right hypochondrium and epigastrium. Most of the liver is hidden under the rib cage. Normally, in the adult, the liver is not palpable below the costal margin (except in thin people during deep inspiration).
The liver may be palpated, at least in lean subjects, by light pressure with the fingertips below the right anterior costal margin. As the subject breathes in deeply, you will feel the displacement of your fingers by the anterior border of the liver as the diaphragm pushes it inferiorly.
What are the surface markings of the gall bladder?
Where transpyloric plane meets the right midclavicular line, which is at the tip of the right 9th costal cartilage or where the lateral border of the rectus abdominis muscle crosses the costal margin.
What are the surface markings of the spleen?
On the left side of the posterior abdominal wall, palpate the 10th rib (using the costal margin as a guide), 11th rib below it and 9th rib above it, along the midaxillary line. The spleen has its long axis along the ribs 9, 10 and 11 on the midaxillary line, and extends medially to the lateral border of erector spinae.
How would you palpate the spleen on the anterior abdominal wall?
The spleen is not usually palpable in a healthy subject. If it is enlarged about 3 times its normal size it can be palpated below the left anterior costal margin.
What are the surface markings of the kidneys?
The transpyloric plane may be extended from the anterior abdominal wall to posterior. It runs through L1 vertebra. The T12 vertebral level is roughly halfway between the inferior angle of the scapula and the highest point of the iliac crest at the scapular line- move one spine down to L1.
Mark the medial border (hilum) about 45cm from the posterior midline.
Each adult kidney is likely to be about 9-12cm long and 5-7cm broad.
The superior poles are covered posteriorly by the 12th ribs.
The inferior poles are about 34cm above the iliac crests.
What are the surface markings of the ureters?
On the posterior abdominal wall, the ureters descend almost vertically from the hila into the iliac fossae.
How would you palpate the lower poles of the kidneys?
On the anterior abdominal wall.
Subject should lie flat on a couch with knees and hips semi-flexed to relax the abdominal wall muscles.
Bimanual palpation: use both hands. Keep the left hand underneath the subject’s flank with palm facing upward (anteriorly) and the fingers in the renal angle (costophrenic angle). Use your right hand to palpate the kidney through the anterior abdominal wall in the upper quadrant. Press down deeply just below the costal margin. Ask the subject to take a deep breath whilst you try to capture the kidney between the 2 hands.
Balloting: you may also ballot the kidney by flexing the index and middle fingers of the left hand at the metacarpophalangeal joints in the renal angle so that the kidney is pushed anteriorly and strikes the right (palpating) hand.
Demonstrate superficial palpation of the abdominal wall
Light palpation in each region using the finger tips. Palm of the hand moulding over the abdominal surface and the fingers flexing at metacarpo-phalangeal joints.
