1. Abdomen Forum 2011

2. Surface Anatomy Guy:
Document where the following organs/structures can be palpated:
Liver
Spleen
Gallbladder
Draw in:
Linea alba
Linea semilunaris
McBurney’s point
ASIS
Deep Inguinal ring
Opening in transversalis fascia
Superficial Inguinal ring
Opening in external oblique 1 2
Linea Alba 3
Liver= can be palpated at its inferior margin below right costal margin, when patient is inhaling deeply (can feel edge of the liver “slipping” over fingers)
Spleen= Press down just below the left costal margin with your right hand while asking the patient to take a deep breath. It may help to use your left hand to lift the lower rib cage and flank (actually not palpable on most individuals)
Gallbladder= normally not palpable; can be if enlarged (from a medical issue) by pressing under the right, middle costal margin, under the rib cage
Spermatic cord goes through entire inguinal canal (males)
Round ligament of uterus (in females)
ASIS 4
Deep inguinal ring
Superficial I.R.

3. Surface Anatomy Guy:
Draw in the 4 lines to create the “9-region pattern”
Name the 9 regions.
What organs are found in each? 1
Right Hypochondrium 2
Left Hypochondrium
Epigastric 3
Right Flank
Left Flank
R.H. = liver Epigastic = liver, gallbladder, stomach, transverse colon L.H. = stomach, spleen, some descending colon
R.F.. = ascending colon Umbilical = small intestine, some transverse colon L.F. = small intestine, descending colo
R.G. = some ascending colon Pubic = small intestine, cecum, appendix, sigmoid colon, rectum, anal canal L.G. = descending colom, small intestine
Umbilical 4
Right Groin
Pubic
Left Groin

4. Patient A – 42 year-old male presenting after trying to move his dishwasher
Compare and Contrast!
Patient B – newborn male
Direct inguinal hernia (more in common in older men with weaker abdominal muscles)
invade Hesselbach’s triangle, and can go through the superficial ring and pick up transversalis fascia
Indirect Hernia (congenital; goes through both inguinal rings)

5. Identify! 1 What's my lymphatic drainage? 2 5 3 4 6
Liver (mostly drained by celiac pre-aortic lymph node; some lymph will pass to inferior phrenic nodes then go to thorax, and round/falciform ligament drains to anterior abdominal wall)
Spleen
Left kidney
Abdominal aorta
Inferior vena cava
Ascending colon

6. 6 Identify! 1 3 2 5 7 4 8 9 Gallbladder Abdominal Aorta
Inferior Vena Cava
Gallstones (referred pain to left shoulder)
Left kidney
Liver
Spleen
Diaphragm (median arcuate ligament)
Hepatic portal vein 5 7

7. Identify! 6 4 5 1 3 2 8 7 Abdominal aorta Right kidney Left kidney
Duodenum (2nd part)
IVC
Liver
Psoas major muscle
Transverse colon 7 2 3

8. Identify! 4 2 1 3 5 6 7 8 Left common iliac artery Right common iliac
Inferior vena cava
Ascending colon (cecum?)
Psoas major m. (hip flexion; attaches to lesser trochanter)
External oblique m.
Internal oblique m.
Rectus abdominis m. 5

9. SUPER BONUS!
Identify!
Superior Mesenteric Artery

10. 6 5 4 2 1 3 Identify; What’s wrong?
48-year-old male with abdominal pain. CT scans reveal:
PANCREOTITIS 6 5 4
Liver
Spleen
Left kidney
Pancreas
Stomach
Heart (right atrium) 2 1 3

11. 44-year-old male with pain in lower right quadrant. CT scan reveals:
History? What’s wrong?
44-year-old male with pain in lower right quadrant. CT scan reveals:
Appendicitis
appendocolith (-lith= stone) with inflammation

12. CT scan of a 50-year-old male reveals:1
Spleen
Right kidney
Peritoneal sac
Ascites 3 2

13. Barium swallow in a 43-year-old female with abdominal pain:
Duodenal Diverticulum (ridges on 3) 2
Pylorus of stomach
Superior part of duodenum
Descending duodenum
Duodenal Diverticulum (not the pancreas)
jejunum 4 3 1 5

14. Barium swallow in a 39-year-old female with dysphagia:
Hint:
What congenital anomaly is responsible?
Dysphagia lusoria
chronic constriction
aberrant right subclavian is going behind the esophagus and pinching it
improper origin

15. MRI of a 9-month-old male with dysphagia and an abdominal mass reveals the following:?
Splenomegaly (by tumor?)
Gaucher’s Disease

16. Barium enema in a 38-year-old female with a abdomino-pelvic mass reveals the following:
Large colonic diverticulosis in the sigmoid colon
filled with poop and blood *

17. Barium enema in a 1-year-old male with difficulty defecating reveals:* *
Stenosis of rectum, sigmoid colon
Hirschsprung’s Disease
lacking nervous innervation, no peristalsis

18. Barium enema and CT scan of a 23-year-old male with a lumbar mass reveals the following:
Lumbar Hernea (through the lumbar triangle)
iliac crest, lat dorsi, external oblique muscles

19. Radiograph from a 73-year-old female with abdominal pain and elevated WBCs:
Hint:
Pneumoperitoneum (gas in the peritoneum)
usually from the disruption of a hollow viscus (in this case, an organ in the GI tract)
can result from a peptic ulcer, bowel obstruction, appendicitis, diverticulitis

20. CT scan from a 30-year-old female with complaints of vomiting and weight loss:
Enlarged spleen; spleen infected and pushing on stomach, leading to vomiting and weight loss 1 3 4
Superior mesenteric syndrome?
Stomach
Right kidney
Portal vein
Superior mesenteric artery 2

21. 24-year-old female presents with the chief compliant of suprapubic pain. A pelvic radiograph reveals:
Stone/mass found in an ectopic kidney
Stone in the bladder (the inferior-most structure

22. GO! 3 5 1 2 4 6 Celiac trunk Splenic artery Left gastric artery
Common hepatic artery
Hepatic artery proper
Gastroduodenal artery
Anterior superior pancreaticoduodenal artery 6 7

23. GO! 1 3 4 2 Superior mesenteric artery Ileocolic artery
Right colic artery
Ileal arteries
RED ARROW= Marginal arter (links the left and middle arteries)

24. GO! 4 3 1 2 Superior Mesenteric Vein Inferior Mesenteric Vein
Splenic Vein
Main Portal Vein 4 3 1 2

25. GO! 1 2 3 Super BONUS! 4 Common hepatic duct Cystic duct
Common bile duct
Main pancreatic duct
SUPER BONUS = lumbar vertebrae (pars interarticularis)
Super BONUS! 4

26. Referred Pain Guy:
A 30-year-old male presents with pain in the region indicated.
What organ is indicated?
What spinal cord levels are involved?
Cell bodies in what location are responsible for relay of pain from this organ?
A 16-year-old female presents with a fever and pain in the region indicated.
Which organ is implicated?
What spinal cord level is involved?
Is this somatic or visceral pain?
A 36-year-old female presents with pain in the region indicated. 1 2 3
YELLOW: 1) Stomach 2) T5-T9 (greater splanchnic) 3) dorsal root T5-T9
RED: 1) Appendix/Small intestine 2) T9-T11 (lesser splanchnic) 3) Visceral pain interpreted as somatic pain (when shifts to right quadrant= SOMATIC)
somatic because it is irritation parietal peritoneum
GREEN: Liver, GALLBLADDER, duodenum 4