Major abdominal landmarks

24 Major abdominal landmarks



24.1 Useful visceral landmarks


Before locating the main abdominal pulses, we will look at a few key landmarks, invaluable in the manual approach to the abdomen (Fig. 24.1).


image

Fig. 24.1 Useful visceral landmarks.



24.1.1 Gastroesophageal junction


The area opposite T11 and inferior to the xiphoid process is an area we approach only in the seated position.



24.1.2 Gallbladder


The gallbladder is located where the right mid-clavicular umbilical line meets the ninth costal cartilage. The gallbladder is only palpable under the ribs and in the seated position.



24.1.3 Duodenojejunal junction


The duodenojejunal junction is found on the left mid-clavicular umbilical line, three fingerwidths above the umbilicus. It is a dependable landmark for radiologists.



24.1.4 Sphincter of Oddi (hepatopancreatic ampulla)


The sphincter of Oddi is situated on the right mid-clavicular umbilical line, three fingerwidths above the umbilicus. This slightly variable point is more or less symmetrical with the duodenojejunal junction.


Remember that the sphincter of Oddi is in the posterior medial wall of the duodenum. Manipulation of this sphincter affects both the hepatopancreatic ampulla and the major duodenal papilla (of Vater).



24.1.5 Pylorus


The pylorus is usually found just to the right of the xiphoid umbilical line, a handswidth superior to the umbilicus. If the person is stressed or the pylorus is active, this sphincter could move more towards the right. Despite its mobility, it is easily palpated.



24.1.6 Ileocecal valve


The ileocecal valve is located one-third of the way towards the umbilicus on the right umbilical–anterior superior iliac spine (ASIS) line.



24.1.7 McBurney’s point


This point is two fingerwidths below the ileocecal valve. Note that it receives sensory innervation from the right 12th intercostal nerve, which anastomoses with the first lumbar nerve root.



24.1.8 The ovaries


The ovaries are located one-third of the distance from the pubis on an ASIS–symphysis pubis line. Their location varies as a function of age and hormonal activity.



24.2 Principal abdominal pulses



24.2.1 The abdominal aorta


The abdominal artery is found between the xiphoid process and the umbilicus, slightly left of the xiphoid–umbilical line (Fig. 24.2).


image

Fig. 24.2 Landmarks for palpation of the abdominal aorta.


The aortic pulse is easiest to feel either superior or inferior to the border of the pancreas. Never place your fingers in an anteroposterior direction. Commence lateral of the artery to avoid picking up the beat of the superior mesenteric artery. Proceed towards the aorta, delicately and gradually.


It is only by placing your fingers on either side of the aorta that you can feel an abdominal aortic aneurysm. Beware if you have the impression that the aorta is more than 4–5 cm wide. Its normal dimension is no more than 3 cm.


Sometimes, for emotional reasons, the abdominal pulse is very powerful and distinct. This can worry the patient, even though it is a normal somatic reaction.


One of the first signs of aortic aneurysm is lumbago or low back pain. If the slightest doubt arises, refer the patient to their physician.


As a preliminary, compare the blood pressure of the upper and lower extremities. The systolic index normally sits at about 0.9 mmHg (see Chapter 6). Check that both femoral pulses are clearly perceptible.


Some aneurysms are located higher up by the renal arteries. These are very difficult to feel manually.

Related posts:

Cardiovascular semiology simplified The posterior auricular artery The inguinal canal Renal vessels Iliac vessels Vessels of the breast

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Nov 7, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Major abdominal landmarks

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