ABDOMEN: SURFACE LANDMARKS AND LINES, ZONES, SURFACE PROJECTIONS

AND LOCATIONS OF ABDOMINAL VISCERA

ABDOMEN ● Region between thoracic and pelvic cavity

● Abdominal diaphragm / Pelvic diaphragm

ABDOMEN PROPER ● BELOW abdominal diaphragm

● ABOVE pelvic inlet

PELVIC CAVITY ● BELOW pelvic inlet

2 Lines 1. Longitudinal Line: xiphoid → symphysis pubis

2. Transverse Line: across umbilicus from iliac crest

Right Upper Quadrant Most common cause of pain

Transverse Division ● Body of L1

● Separates upper sections
● Passes through tip of R costal cartilage on both
sides
○ Pylorus of stomach
○ Duodenojejunal junction
○ Neck of Pancreas
○ Hila of Kidney

Transtubercular Plane ● Iliac tubercle side to side

Greater Omentum ● Fatty tissue hanging to greater curvature going

downward
● First to be seen upon dissection
● Covers the entire abdominal cavity
● Soldier of abdominal cavity
● Stops spread of infection
● Hangs down in front of the coils of small intestine and
folded back to itself to be attached to transverse colon

Lesser Omentum ● Suspends lesser curvature of stomach from

ligamentum venosum and porta hepatis on
undersurface of liver

Gastrosplenic Omentum ● Connects stomach to hilum of spleen

Xiphoid process ● Thin, cartilaginous structure

● Easily palpated
● T9

Costal margin ● Lower margin of thoracic wall

● Formed in front by cartilages of 7,8,9,10
● Lowest margin: 10th rib
● Body of L3
Iliac Crest ● Highest point of pelvic bone
● Opposite body of L4
● Felt along entire length
● In front: ASIS
● Behind: PSIS

Tubercle of Crest ● 5cm posterior to ASIS

● Impt when identifying transtubercular plane
● More lateral than inguinal ligament

Inguinal Ligament ● Under inferior margin of External Oblique

Aponeurosis
● Lateral to ASIS
● Medial to PUBIC TUBERCLE

Pelvic Tubercle ● Small protuberance along the superior surface of the

pubis.
● Medial attachment of inguinal ligament

Symphysis Pubis ● Cartilaginous bone lying in midline between bodies

of 2 pubic bones

Pubic crest ● Ridge on the superior surface of the pubic bones

medial to the pubic tubercle

Superficial Inguinal Ring ● Triangular aperture in the aponeurosis of the external

oblique muscle above
● Medial: Pubic Tubercle
● Margin felt by invaginating the skin of upper scrotal
area with the tip of little finger

Spermatic Cord ● Emerge from superior inguinal ring

● Lies over or medial to the pubic tubercle →
scrotum

Vas Deferens Firm, cord like structure in the posterior part of sperm cord

Scrotum Pouch of skin containing testes, epididymis and lower

ends of the spermatic cord

Linea Alba ● Fibrous band

● Extends from symphysis pubis
● Ends at xiphoid process
● Lies in the midline
● Formed by fusion of aponeurosis of the muscles of
the anterior abdominal wall
● Represented by slight median groove on the surface

Umbilicus ● Lies in the linea alba

● Inconstant position
Linea Semilunaris ● Lateral edge of rectus abdominis
● Cross the coastal margin at the tip of the 9th costal
cartilage

Transpyloric plane Passes through tip of right costal cartilage on two sides
→ point where where lateral margin of rectus abdominis
crosses the costal margin

Passes through:
1. Pylorus
2. Duod jejunal junction
3. Neck of pancreas
4. Hilum of kidney

Abdominal Viscera 1. Liver

2. Gallbladder
3. Spleen
4. Pancreas
5. Kidneys
6. Abdominal Aorta
7. External Iliac Artery
8. Urinary bladder and pregnant uterus

LIVER ● Largest solid organ

● Most likely to be affected after BLUNT TRAUMA
● Right upper quadrant

GALLBLADDER ● Right Hypochondriac Region

● Attached to: LOWER PORTION OF LIVER
● Fundus of the Gallbladder: 9th Costal Cartilage
● Inflammation and Stone Formation
● Cholecystectomy

SPLEEN ● Left Hypochondriac Region

● Left Upper Quadrant
● One of the structures ruptured in a blunt abdominal
injury

PANCREAS ● Epigastric Region

● Mostly located retroperitoneally
● Tail: intraperitoneally
● Close association with descending portion of
duodenum medially and spleen laterally

KIDNEYS ● Retroperitoneally
● Right and left lumbar area
● Right kidney: slightly lower level because of the bulk
of the right lobe of the liver

EXTERNAL ILIAC ARTERY ● From common iliac artery → divides into femoral
artery
ABDOMINAL AORTA ● Retroperitoneally
● Midline together with inferior vena cava

Divide into:
● 2 common iliac arteries → internal and external
artery on intercristal plane @ L4

URINARY BLADDER Hypogastrium in pelvic cavity

Pregnant Uterus ● Hypogastrium

● Fundal Height to measure age of gestation

If fundus of uterus is:

● Above symphysis pubis: 12 weeks AOG
● Halfway point: 16 weeks AOG
● Umbilicus: 20 weeks AOG
● Xiphoid Process: 36 weeks AOG
● 40 weeks AOG: fundal height regresses at 4cm

JEJUNUM AND ILEUM

GIT Segments 28 - 35 ft

1. Mouth
2. Esophagus
3. Stomach
4. Small Intestine
● Duodenum
● Jejunum
● Ileum
5. Cecum - attachment of Ileum before becoming large
intestine
6. Large Intestine
● Ascending colon
● Hepatic Fixture
● Transverse Colon
● Splenic Flexure
● Descending Colon
● Sigmoid Colon
7. Rectum
8. Anal canal & Anus

3 portions of small intestines ● Duodenum

● Jejunum
● Ileum
Duodenum Right after pylorus
Termination: Ligament of Treitz

Jejunum Right after duodenum

Proximal 40% of Jejuno-ileal segment
8-9 feet

Ileum Distal 60% of Jejuno-ileal segment

9-12 feet

Layers of Small Intestine 1. Serosa: Outermost

2. Muscular Layers
● Outer longitudinal muscle fibers
● Internal circular muscle fibers
3. Submucosa
4. Mucosa: Innermost

Average time of SOLID food 2-4 hours

composition to stay in the
stomach before traveling to
duodenum

Average time of LIQUID food 15-30 minutes

composition to stay in the
stomach before traveling to
duodenum

Convolutions Folds of the mesentery in the small intestine

Increase surface area for nutrient absorption (villi)

Acute Gastroenteritis Pain on pelvic area especially if the site of inflammation is in

the terminal ileum or part of the jejunum

Cavities Occupied by Majority: Abdominal Cavity

Jejuno-ileal segment Minority: Pelvis

Specific parts of pelvis Terminal ileum (except last 2 inches) - right iliac fossa
occupied by jejuno-ileal 3 - 5 feet of distal jejunum
segment

Muscular layer of Small Small intestine from its beginning at the pylorus up to its end
Bowel at ileocecal valve is covered by 2 layers of dynamic muscles

External coat of longitudinal Lengthens and shortens bowel

fibers

Internal layer of circular fibers Contracts and relaxes the bowel

Short contract

Lengthens relax
Longitudinal muscles shorten Circular muscles close

Longitudinal muscles Circular muscles open

lengthen