5MBBS201 FROM SCIENCE TO SYSTEMS
LIVING ANATOMY OF THE ABDOMEN
Session outcomes
The main outcome of this session is for students to become proficient in the use of
ultrasound and familiar with this imaging modality as an adjunct to organ palpation. Being
experienced/skilled in ultrasound imaging is an increasing requirement for today’s and
tomorrow’s doctors, so do exploit this opportunity fully.
We will be focusing on the liver, kidneys and spleen as the organs of interest, as these
are often the target of examination through palpation as well as ultrasound imaging. So
split into small groups to undertake the following tasks over the two-hour period:

Listen to the (short) account by the anatomy demonstrators regarding the palpation
of the liver and kidneys – roughly 15 mins

Draw the location of these organs on a willing participant – roughly 30 mins

Apply the ultrasound tool to image these abdominal organs, taking the opportunity
to recall the main anatomical features covered in phase 1 – minimum 60 mins
The ultrasound element should take the majority of the session’s allocated time, so timemanagement is crucial and follow the guidance by the demonstrators.
Materials to be used in session

Alcohol gel, to sanitize hands prior to palpation

Mark-up pens to draw surface markings on the skin

Ultrasound machine, to image heart location and function.
5MBBS201 FROM SCIENCE TO SYSTEMS
Living Anatomy of the Abdomen_V1
Ricardo Governo, Oct 2022
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Task 1. Drawing the surface projection of the liver
Using the figure and text below as a guide, draw the borders of the liver on a participant.
Upper border
 First, palpate for the xiphisternal joint (A on the figure) then draw a small line over it.
This marks approximately the midpoint between the left and right lobes of the liver (A
on the figure)
 On the right-hand side locate where the midclavicular line crosses the 5 th intercostal
space. Place another mark about 1cm to the right of that (B on the figure)
 Repeat for the left-hand side, but this time on the 6th intercostal space (C on the figure).
Now join these three points as shown in the figure
Right border
 Palpate the area where the right costal margin crosses the midaxillary line. Place a
point about 1 cm below
 Draw a curved line, convex to the right, from this point to the right end of the upper
border (B on the figure)
Inferior border
 Simply draw another fairly straight line connecting the inferior point of the right border
to the leftmost point of the upper border
5MBBS201 FROM SCIENCE TO SYSTEMS
Living Anatomy of the Abdomen_V1
Ricardo Governo, Oct 2022
2
Task 2. Observe/discuss the following



The liver occupies mostly the right hypochondrium
When viewed from the front, the ribs cover a significant proportion of it. Listen to the
demonstrator explain why patients are asked to breathe in (which forces the liver
downwards) so that they can palpate this organ properly
The point where the line that represents the lower border crosses the midsagittal line
falls over the transpyloric plane.
Task 3. Drawing the surface projection of the gall bladder
The fundus of the gall bladder projects from the lower surface of the liver
 Palpate for the right 9th intercostal space
 Move in a horizontal direction towards the costal margin
 Where it crosses the right midclavicular line draw a small circle (fundus of gall bladder)
Task 4. Drawing the surface projection of the kidneys
Turn to the participant’s back or ask the participant to rotate to the prone position if lying
down. Either way the participant should keep the arms alongside the body

The hilum of the left kidney is located at the cross
point between the lower border of the spine of the first
lumbar vertebra* and about 5 cm from the mid-dorsal line.
*Note: If unsure where L1 can be felt, merely extend the
transpiloric plane posteriorly

From this point, draw a kidney-shaped figure 11 cm
long and 4-5 cm wide. Repeat for the right hand side but
draw the hilum approximately 2.5 cm lower.

The transpiloric plane should pass across the upper
region of the right kidney. If done correctly the lowest point
of the right kidney should end about 2.5 cm above the highest point of the iliac crest.
Note: The right kidney is usually at a slightly lower level than the left because of the great
mass of the liver. Also the kidneys fall about 2.5 cm lower if the subject is standing
compared to when lying down plus move up and down with respiration, as does the liver.

Finally, draw the spleen as a fist-sized, oval shape organ overlying the 9-11th rib, with
its medial edge at about 5-6cm from the mid-dorsal line, as shown above
5MBBS201 FROM SCIENCE TO SYSTEMS
Living Anatomy of the Abdomen_V1
Ricardo Governo, Oct 2022
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Task 5. Ultrasound imaging of the abdomen
The purpose of this task is to introduce to POCUS (point of care ultrasound), which will
be taught later in your course. At this stage it is important to learn about eFAST (Extended
Focused Assessment with Sonography for Trauma), which assesses abdominal free fluid.
Thus, its structures of interest include the diaphragm, liver, spleen, kidneys or bladder.
The liver (transverse view)
•
Use the curved probe, which is specifically designed to view abdominal or pelvic
visceral organs
•
Place the probe over the midsagittal line and roughly half-way between the xyphoid
process and the pubic tubercle, in the same region as that indicated in the figure below,
so that the left-hand side of the image corresponds to the right-hand side of the body
•
Adjust
the
image
scale to a new depth of 15
cm,
so
that
the
deep
features of the liver can be
viewed.
The liver (transverse view, from
anterior to posterior:
1. LL – left lobe, PV – portal vein, LV
– ligamentum venosum, IVC –
inferior vena cava, Ao – aorta, Sp –
Spine, RL – right lobe, Di –
diaphragm;
2. LHV – left hepatic vein, MHV – mid
hepatic vein, RL – right lobe, RHV –
right hepatic vein, Di – diaphragm;
3. LT – ligamentum teres, RL – right
lobe, GB – gall bladder, IVC – inferior
vena cava, RK – right kidney.
* Source: Dilley, modified from Gray’s
Surface Anatomy and Ultrasound
(Elsevier). ©
5MBBS201 FROM SCIENCE TO SYSTEMS
Living Anatomy of the Abdomen_V1
Ricardo Governo, Oct 2022
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•
Try to locate the structures labelled in the top row of this figure
•
Once satisfied with these move the probe to position 2, or middle row, and repeat
the exercise, and finally for position 3 using the figure as a guide.
The kidney (coronal view)
•
Ask the participant to lean to his/her right and to raise the left arm, as indicated in
the figure below
•
Place the probe along the midaxillary line at the point where the predicted location
of the kidney was drawn
•
Adjust the field of view to a depth of 13 cms so that it captures the deeper
structures of interest, such as the ureters.
The left kidney cut in the mid coronal plane, to reveal both the renal pelvis
and ureter. From superficial to deep: RC – renal cortex, * – renal pyramid, †
– renal column, RS – renal sinus, RP – renal pelvis, Ur – ureter.
* Source: Dilley, modified from Gray’s Surface Anatomy and Ultrasound
(Elsevier). ©
•
Identify the main subdivisions of the kidney as shown in the figure above
•
Note the extensive amount of perirenal fat, as well as that occupying the renal
sinus. That not only cushions the kidney but also helps to retain bloodflow temperature.
5MBBS201 FROM SCIENCE TO SYSTEMS
Living Anatomy of the Abdomen_V1
Ricardo Governo, Oct 2022
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The spleen
If time permits and all in the group are satisfied with imaging the liver and kidneys then
try to image the kidney
•
With the participant still lying on his/her side, rotate the probe so that it is at a
normal angle, as shown in the figure below, with the left-hand side of the display
corresponding to the anterior surface of the body
•
The operator will also need to adjust the position and inclination of the probe so
that the sound beam is not blocked by ribs, and the field of view. Imaging may require a
few attempts. Ask a demo for assistance if struggling.
Axial view of the spleen and neighbouring left kidney. From superficial
to deep: Sp – spleen, LK – left kidney, Hi – hilum.
* Source: Dilley, modified from Gray’s Surface Anatomy and
Ultrasound (Elsevier). ©
5MBBS201 FROM SCIENCE TO SYSTEMS
Living Anatomy of the Abdomen_V1
Ricardo Governo, Oct 2022
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