Page 72 - Clinical Anatomy

ECA2 7/18/06 6:42 PM Page 57

Surface anatomy and surface markings 57

Liver
The lower border of the liver extends along a line from the tip of the right
10th rib to the left 5 th intercostal space in the mid clavicular line; it may just
be palpable in the normal subject, especially on deep inspiration. The upper
border follows a line passing through the 5th intercostal space on each
side.

Spleen
This underlies the 9th, 10th and 11th ribs posteriorly on the left
side commencing 2 in (5cm) from the midline. It is about the size of the
subject’s cupped hand.

Gall-bladder
The fundus of the gall-bladder corresponds to the point where the lateral
border of the rectus abdominis cuts the costal margin; this is at the tip of the
9th costal cartilage, easily detected as a distinct ‘step’ when the fingers are
run along the costal margin.

Pancreas

The transpyloric plane defines the level of the neck of the pancreas which
overlies the vertebral column. From this landmark, the head can be imag-
ined passing downward and to the right, the body and tail passing
upwards and to the left.

Aorta
This terminates just to the left of the midline at the level of the iliac crest at
L4; a pulsatile swelling below this level may thus be an iliac, but cannot be
an aortic, aneurysm.

Kidneys
The lower pole of the normal right kidney may sometimes be felt in the thin
subject on deep inspiration. Anteriorly, the hilum of the kidney lies on the
transpyloric plane four finger breadths from the midline. Posteriorly, the
upper pole of the kidney lies deep to the 12th rib. The right kidney normally
extends about 1in (2.5cm) lower than the left. Using these landmarks, the
kidney outlines can be projected on to either the anterior or posterior
aspects of the abdomen.
In some perfectly normal thin people, especially women, it is possible
to palpate the lower pole of the right kidney and the sigmoid colon if
loaded with faeces; in most of us, only the aorta is palpable.