Position of the Organs – Surface Anatomy of the Abdomen

00:00 This is a cartoon which you are probably very familiar with because you have gone through your education and the... just the idea of where the organs are within the abdominal cavity. So, here, we can see we have got the sternum, here, now, we can see the xiphisternum, this inferior limit of the sternum which demarcates the superior aspect of the abdomen and then we can see it radiating down in this direction with those costal cartilages. We can see really clearly now tucked up on this right hand side protected by the ribs, we have got the liver, this large organ, the largest gland in the human body. And in the midline, we can see just above, we have got the stomach here which is then continuous with what’s called the duodenum and that’s the first part of the small intestine. But, previously, I mentioned the appendix down in this lower right inguinal region. And here we can see in the lower right inguinal region, we can actually find the appendix. So, these are really important landmarks which we can identify in the abdominal cavity. This is an anterior view. Over here, we have got a posterior view and we can see where the kidneys are located either side of the vertebral column. We can also see tucked away here, we have the spleen which you can just about make out on this left hand side.

01:26 So, we will look at the various positions of these organs as we go through the course, but this provides a good general overview. So, now, we can relate the surface landmarks that we spoke about previously to a couple of these organs like the liver and the appendix.

01:42 Here, we can start off with the appendix, this blind pouch that’s located at the beginning of the large intestine by the caecum and this is really important because as I mentioned before, we may have radiating pain coming from this region. So, a useful technique for locating this pain is to use what’s known as McBurney’s point and this is a surface landmark for the appendix. So, again, we can remind ourselves of where the umbilicus is, we can see it here, we can remind ourselves of where the anterior superior iliac spine is and as we can see in the diagram, we can draw a line between these two regions. A third of the way from the anterior superior iliac spine towards the umbilicus, so about a third of the way across, we can locate our appendix and that’s known as McBurney’s point.

02:39 Palpation in this region can lead to quite severe, acute pain and this could indicate that the patient maybe has appendicitis. So, that’s where the surface landmarks are really important in being able to identify which organs lie deep to the skin. We can also see over on this side again I mentioned it in the previous slide, the position of the liver.

03:01 And here, we can see that actually the liver is hard to palpate because most of the liver is actually covered by these ribs and here, this diagram may not be a hundred percent correct in that it’s quite unusual for the liver to actually be so clearly observed, free of the ribs. It is usually only in patients that have an enlarged liver that it can actually radiate below the ribs and to palpate the liver, you can feel this costal margin and asking the patient to breath in and out moves the liver and you can actually, pressing on the skin deep to these ribs, can feel this edge of the liver pressing against your fingers.

03:39 So, it is really important that we mention the surface landmarks as you can use them to try and feel and locate organs deep to the skin.