Lecture out Line

SURFACE ANATOMY OF ABDOMEN Learning Objectives A. At end of class students should understand. 1. surface marking of stomach. 2. Surface marking of spleen, 3. Surface marking of liver, 4. Surface marking of gall bladder, 5. Surface marking of kidney, 6. Surface marking of appendicular orifice.

LECTURE OUT LINE Surface marking of stomach 1. Cardiac orifice. 1. Two short parallel lines 2cm apart. Directed to downwards & left on 7th costal cartilage. 2.5 cm to left median plane.

Stomach 2. Pyloric orifice. 1. Marked by two short parallel lines 2cm apart , directed upwards & t Stomach 3. Lesser curvature. 1. Marked by joining the right margin of cardiac orifice with upper margin of pyloric orifice by a j shaped curved line. Lowest point of this line reaches o little below the transpyloric plane.

4. Fundus. 1. marked by convex line upwards drawn from left margin of the cardiac orifice to highest point in left 5th intercostal space below the nipple.

5. Greater curvature. 1. curved line convex to left & downwards, drawn from fundus to lower margin of the pyloric orifice. 2. it cuts the left costal margin b/w tips of 9th & 10th costal cartilages & extends down to sub costal plane.

Surface marking of spleen • A. marked on left side of the back, with its long axis corresponding with that of 10th rib. • B. upper border corresponds to upper border of 9th rib & lower border to lower border of 11th rib.

Spleen c. Medial end lies 4-5 cm from midline.& lateral end at midaxillary line. Spleen • Spleen lies obliquely along the long axis of the 10th rib. • Directed downwards, forwards & laterally ,making an angle of about 45 degree with horizontal plane Surface marking of liver • Triangular in shape when seen from front. Liver surface marking a. Upper border is marked by joining the following points. a. 1st point in left 5th intercostal space 9cm from median plane. b. 2nd point at xiphisternal joint. c. 3rd point at upper border of right 5th costal cartilage in right lateral vertical plane. d. 4th point inferior border of right scapula. e. 6th point at 8th thoracic spine Liver b. Lower border is marked by curved line joining the following point. 1. 1st point at left 5th intercostal space 9 cm from the median plane. 2. 2nd point. at tip of 8th costal cartilage on left costal margin.

Liver • Lower border. 3. 3rd point at transpyloric plane in midline. 4. 4th point at tip of 9th costal cartilage on right costal margin. 5. 5th point 1cm below right costal margin at tip of 10th costal cartilage. 6. 6th point at 11th thoracic spine

Liver • Right border. Is marked on front by curved line convex laterally drawn from a point a little below the right nipple to point 1 cm below the right costal margin at tip of 10th costal cartilage. Visceral relations of liver A. Anterior surface . A. Xiphoid process. B. Anterior abdominal wall. in median plane. C. Diaphragm. On each side.

A. Superior surface . A. Cardiac impression. B. Dome of Diaphragm. B. Right surface . A. Upper 1/3 A. Diaphragm. B. Pleura. C. Lung. B. Middle 1/3. A. Diaphragm. B. Cost diaphragmatic recess C. Lower 1/3 to . A. Diaphragm. Surface marking of gallbladder. • Fundus of gallbladder is marked at. • Anterior abdominal wall .at tip of the 9th costal cartilage. Where transpyloric plane crosses the right costal margin (at lateral border of right rectus sheath. Kidneys on back • Marked within Morris parallelogram drawn in following way. – Two horizontal lines are drawn., one at level of the 11th thoracic spine & other at the level of 3rd lumbar spine. • Then two vertical lines are drawn . – One 2.5 cm & other 9cm from median plane. • Hilum lies opposite the lower border of 1st lumbar spine. Lower on right side.

Kidneys on front • Bean shaped kidney is marked with following specifications. • 1. on right side the centre of hilum lies 5cm from median plane a little below the transpyloric plane. • 2. on left side it lies 5cm from median plane a little above transpyloric plane , just medial to tip of 9th costal cartilage. Surface marking of kidneys.

• Kidneys measures 11*5 cm. • Marked both on front & back Kidneys 3. Upper pole 4-5 cm from midline , ½ way b/w xiphisternum & transpyloric plane. Right one little lower. 4. Lower pole lies.6-7 cm from the midline on right side at umbilical plane & on left side sub costal plane. Appendicular orifice • Marked on surface by a point 2 cm below junction of transpyloric plane & right lateral plane. • Mc Burney's point lies at the junction of lateral 1/3 & medial 2/3 of line joining the right anterior superior iliac spine. to umbilicus.