Topography of the abdomen
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Topography
Abdominal topography describes the structure of the abdominal wall and its topographical areas. Furthermore, it describes the peritoneal cavity and retroperitoneal space, which is the space behind the peritoneum. On the abdominal surface, there are nine areas separated from each other by three horizontal and two vertical imaginary lines. Regions
The spinoumbilical line of Monro (linea spinoumbilicalis) is a connection of the right superior anterior iliac spine and umbilicus. The semilunar area (space) of Traube is a place under the left costal arch, in which the fundus of the stomach can be found.
Anatomical and clinical terms
• 1 Epigastric region (regio epigastrica) • 2 Right hypochondrium (regio hypochondriaca dextra) • 3 Left hypochondrium (regio hypochondriaca sinistra) • 4 Umbilical region (regio umbilicalis) • 5 Right lateral region (regio lateralis dextra) • 6 Left lateral region (regio lateralis sinistra) • 7 Pubic region (regio pubica) • 8 Right inguinal region (regio inguinalis dextra) • 9 Left inguinal region (regio inguinalis sinistra)
The abdominal region can be easily divided into four quadrants by two perpendicular lines crossing the umbilicus
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Lines
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1 Xiphosternal line (linea xiphosternalis) – a horizontal line passing through the junction of the body of the sternum and xiphoid process 2 Subcostal line (linea subcostalis) – a horizontal line passing through the lowest points of the costal arches 3 Interspinous line (linea interspinosa) – a horizontal line passing through the superior anterior iliac spines 4 Left midclavicular line (linea medioclavicularis sinistra) – a vertical line passing through the middle of the left clavicle 5 Right midclavicular line (linea medioclavicularis dextra) – a vertical line passing through the middle of the right clavicle 6 Transpyloric line of Addison (linea transpylorica) – a horizontal line between the sternal ends of the 9th ribs
The extraperitoneal fascia (fascia extraperitonealis) is a layer of reticular fibrous tissue between the peritoneum and parietal abdominal fascia. Its thickness varies a lot, it is thick and filled with adipose tissue on the back (pararenal fat pad), but thin and fibrous on the abdomen, mostly at the linea alba. The abdominal fasciae page 130.
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Organ projection on the anterior abdominal wall
• 1 Triangle of Labbé
– a projection of the stomach (it touches the abdominal wall) – three sides: a connection of the 9th rib cartilage on the right and 8th rib cartilage on the left, left costal arch, transpyloric line 2 Pancreatic point of Desjardins – a projection of the major duodenal papilla of Vater – on the line connecting the umbilicus and apex of the right axilla, 6–7 cm from the umbilicus 3 Point of Murphy – a projection of the fundus of the gallbladder (it touches the abdominal wall) 3 – an intersection of the right costal arch 2 and right midclavicular line 4 Point of McBurney – a projection of the origin of the vermiform appendix from the caecum – a one-third distance between the superior anterior iliac 4 spine and umbilicus (line of Monro) 5 5 Point of Lanz – a projection of the vermiform appendix in the pelvic cavity (only in case of its pelvic position) – at the border of the right and middle third of the interspinous line 6 Point of Sonnenberg – a projection of the vermiform appendix in the pelvic cavity (only in case of its pelvic position) – an intersection of the interspinous line and lateral margin of the right rectus abdominis
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Clinical notes Peritoneal puncture is mostly performed on the line connecting the umbilicus and left superior anterior iliac spine, between its left and middle third. Under ultrasound control, we can also choose a different access. The point of McBurney is a place of maximum pressure pain when inflammation of the vermiform appendix (acute appendicitis) occurs. The sign of Traube is a dull percussion in the area of Traube which means an enlargement of the spleen.