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1-Anatomy Flashcards

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1
Q

What are the planes that make up the 9 abdominal regions?

A

Horizontal: Transpyloric: Halfway between xiphoid process and umbilicus, passes through pylorus of stomach
Intertubercular: Horizontal line that joins the iliac crest
Vertical: Midclavicular

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2
Q

What are the planes that make up the 4 quadrants of the abdominal cavity?

A

Transumbilical: Passes between umbilicus and IV disc between L3 and L4 vertebrae
Median: Passes through middle of pubic symphysis, splits abdomen into left and right

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3
Q

What are the layers from the skin to the parietal peritoneum?

A 
Skin
Superficial fascia (beneath umbilicus - fat- camper, then membranous layer - Scarpa)
Investing fascia 
External oblique 
Investing fascia 
Internal oblique
Investing fascia 
Transverse abdominus 
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum
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4
Q

What is the inguinal ligament formed by?

A

Inferior margin of the external oblique and a fibrous band

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5
Q

Where does the inguinal ligament span between?

A

Anterior superior iliac spine and the pubic tubercle

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6
Q

What direction do the fibres of external oblique run in?

A

Inferomedially - HANDS IN POCKETS

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7
Q

What direction do fibres of internal oblique run in?

A

Superiomedially

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8
Q

What direction do fibres of transverse abdominis run?

A

Horizontally

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9
Q

What does the different direction of the flat muscle fibres do?

A

Strengthen abdominal wall

Decrease risk of herniation

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10
Q

What is the rectus sheath?

A

An aponeurosis of the medial parts of the flat muscles, enclosing the rectus abdominus, the pyramidalis muscles

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11
Q

What are the divisions of the rectus sheath?

A

Posterior wall: Aponeuroses of internal oblique and transverse abdominis
Midway between umbilicus and pubic symphysis, all aponeuroses move to anterior wall
Anterior wall: Aponeuroses of external and internal obliques

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12
Q

What is the arcuate line?

A

The transition between the rectus abdominus having a posterior wall and not, so is in direct contact with the transversalis fascia. Located midway between the umbilicus and pubic symphysis.

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13
Q

What is the linea alba?

A

Where the aponeuroses of the flat muscles entwine in the midline, splitting rectus abdominus in two. Extends from xiphoid process to pubic symphysis

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14
Q

What are the flat muscles?

A

External oblique
Internal oblique
Transverse abdominus

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15
Q

What are the vertical muscles?

A

Rectus abdominis

Pyramidalis

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16
Q

What are the attachments and innervation of external oblique?

A

Origin: Ribs 5-12
Insertion: Iliac crest and pubic tubercle
Innervation: Intercostals (T7-11) and subcostal (T12)

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17
Q

What are the attachments and innervation of internal oblique?

A

Origin: Inguinal ligament, iliac crest and thoracolumbar fascia
Insertion: Ribs 10-12
Innervation: Intercostals (T7-11), subcostal (T12) and L1 - iliohypogastric and ilio-inguinal

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18
Q

What are the attachments and innervation of transversus abdominus?

A

Origin: Inguinal ligament, costal cartilages 7-12, iliac crest and thoracolumbar fascia
Insertion: Conjoint tendon, xiphoid process, pubic crest
Innervation: Intercostals (T6-11), subcostal (T12) and L1 - iliohypogastric and ilioinguinal

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19
Q

What is the function of external oblique?

A

Compress the abdominal viscera (aids in expiration, micturition, defecation)
Bilateral contraction: Flexion of vertebral column
Unilateral contraction: Lateral rotation of vertebral column, ipsilateral shoulder moves anteriorly

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20
Q

What is the function of the internal oblique?

A

Compresses the abdominal viscera (aids in expiration, micturition, defecation)
Bilateral contraction: Flexion of vertebral column
Unilateral contraction: Lateral rotation of vertebral column, contralateral shoulder moves anteriorly

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21
Q

What is the function of transversus abdominus?

A

Compresses the abdominal viscera (aids in expiration, micturition, defecation)

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22
Q

What is the linea semilunaris?

A

The lateral border of the paired rectus abdominus muscles, runs from 9th rib to pubic tubercle

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23
Q

What are tendinous intersections?

A

3 Fibrous strips that intersect the rectus abdominis muscle to create the six pack

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24
Q

What are the attachments and innervation of rectus abdominis?

A

Origin: Pubic crest and symphysis
Insertion: Xiphoid process and costal cartilages 5-7
Innervation: Intercostals (T7-11) and subcostal (T12)

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25
What is the function of rectus abdmoninis?
Depresses the ribs, flexes vertebral column, tenses anterior abdominal wall
26
Between which layers of the abdominal wall will fluid from the perineal region spread?
Between fatty fascia (Scarpa's) and the investing fascia of external oblique
27
Where is pyramidalis in relation to rectus abdominis?
Superficial and inferior to it
28
Which of the abdominal wall muscles is missing in 20% of people?
Pyramidalis
29
What are the attachments and innervation of pyramidalis?
Origin: Pubic crest and symphysis Insertion: Linea alba Innervation: Subcostal (T12)
30
What is the function of pyramidalis?
Tenses linea alba
31
What is the action of the abdominal muscles during inspiration?
When diaphragm contracts, abdominal muscles relax to make room for the abdominal viscera that are pushed inferiorly
32
What is the action of the abdominal muscles during expiration?
Contract to increase intra-abdominal pressure, elevating the diaphragm so air can be expelled
33
What type of cell makes up the peritoneum?
Mesothelium - Simple squamous epithelial cells
34
What does the parietal peritoneum do?
Lines internal surface of abdominopelvic wall
35
Where does the parietal peritoneum derive from and how does this affect its innervation?
Derived from somatic mesoderm Innervated by the same somatic nerves as the abdominal wall it lines so pain is well localised and sensitive to pain, pressure and temperature
36
What does the visceral peritoneum do?
Invaginates to cover abdominal viscera
37
Where does visceral peritoneum derive from and how does this affect its innervation?
Derived from splanchnic mesoderm Innervated by same nerves as the viscera it invests, so pain is poorly localised and referred to dermatomes that are supplied by same ganglia as nerves innervating the viscera. Sensitive only to stretch and chemical irritation
38
Define and give examples of intraperitoneal organs
Organs completely covered by visceral peritoneum | Eg Stomach, liver, jejunum and spleen
39
Define retroperitoneal organs
Organs covered in peritoneum only on their anterior surface
40
Define and give examples of primarily retroperitoneal organs
Organs that develop and remain outside the parietal peritoneum eg oesophagus, rectum and kidneys
41
Define and give examples of secondarily retroperitoneal organs
Organs that were initially intraperitoneal, suspended by mesentery. Become retroperitoneal, mesentery fuse with posterior abdominal wall, so peritoneum only covers anterior surface E.g. Ascending and descending colon
42
Which abdominal viscera are retroperitoneal?
``` SAD PUCKER Suprarenal (adrenal) glands Aorta/IVC Duodenum - except duodenal cap Pancreas - except tail Ureters Colon - ascending and descending Kidneys Esophagus Rectum ```
43
Define mesentery
A double layer of visceral peritoneum, connecting an intraperitoneal organ to the (posterior) abdominal wall. Develops from splanchnic mesoderm
44
How is mesentery named?
Small intestine - the mesentery | Everywhere else named according to viscera it connects to
45
What is the omentum?
Double layer of peritoneum that extends from stomach and proximal duodenum
46
What are the attachments of the greater omentum?
Descends from greater curvature of stomach and proximal duodenum passing in front of small intestines Then fold back up to attach to the anterior surface of transverse colon
47
What are the functions of the greater omentum?
Physically limit spread of intraperitoneal infection as wraps around affected area Fat deposition
48
What does the greater omentum develop from?
Develops from dorsal mesentery that connects stomach to posterior abdominal wall
49
What does the lesser omentum develop from?
Ventral mesentery
50
What are the attachments of the lesser omentum?
Attaches from the lesser curvature of the stomach and proximal duodenum to liver via hepatogastric and hepatoduodenal ligaments
51
Define peritoneal ligament
Double fold of peritoneum that connects viscera together or to abdominal wall
52
Where are is the pain from the embryological regions referred to?
Foregut to Epigastric Midgut to umbilical Hindgut to pubic
53
What does the foregut develop to?
``` Oesophagus Stomach Pancreas Liver Gallbladder Duodenum (proximal to common bile duct) ```
54
What does the midgut develop to?
``` Duodenum (distal to common bile duct) Jejunum Ileum Cecum Ascending colon Proximal 2/3rds transverse colon ```
55
What does the hindgut develop into?
``` Distal 1/3rd transverse colon Descending colon Sigmoid colon Rectum Upper anal canal Internal lining of bladder and urethra ```
56
Where is pain from retroperitoneal organs referred to?
The back
57
Where does irritation of bladder present?
As shoulder tip pain
58
Describe how appendicitis pain is referred
Initially pain from the appendix and visceral peritoneum is referred to the umbilical region as appendix is a midgut structure. As inflammed appendix irritates the parietal peritoneum, pain becomes localised to the right lower quadrant
59
What is a volvus?
When the intestine becomes twisted around an adhesion, causing bowel obstruction
60
What is a peritoneal adhesion?
Inflammation of peritoneum leads to fibrous scar tissue forming, which cause abnormal attachments between visceral and parietal peritoneum
61
How does the embryo fold in the 4th week?
Laterally: Creates ventral body wall and primitive gut becomes tubular Craniocaudally: Creates cranial and caudal pockets from yolk sac endoderm, beginning primitive gut development
62
Describe the primitive gut tube
Endoderm lined tube (future epithelial lining) Runs between stomatodeum (mouth) and proctodeum (anus) Opening at umbilicus Covered in splanchnic mesoderm (future muscules and visceral peritoneum) Suspended in intraembryonic colem by a double layer of splanchnic mesoderm
63
Describe how the stomach develops
Mid week 4, dilation of distal foregut indicates final position of stomach Faster growth of dorsal border creates greater curvature Stomach rotates, changing position of dorsal and ventral mesenteries, forming omental bursa and displacing lesser sac posteriorly from the right
64
Describe the arterial supply to each segment of the gut tube
Foregut - celiac trunk Midgut - superior mesenteric (upper) and abdominal aorta (lower) Hindgut - inferior mesenteric artery
65
What are the exceptions to the normal arterial supply of the gut?
Viscera close to the junction between foregut and midgut, have mixed supply Duodenum: Proximal to bile duct = Gastroduodenal and superior pancreaticoduodenal - branches of celiac trunk Distal to bile duct = inferior pancreaticoduodenal - superior mesenteric Pancreas: Head supplied by superior pancreaticoduodenal (CT) and inferior pancreaticoduodenal (SMA)
66
What is the intraembryonic coelom?
Cavity formed as embryo folds in week 4, that later will be divided into thoracic and abdominal by diaphragm
67
What is the function of the mesenteries?
Allow a conduit for blood/nerves | Allow mobility so gut can move food
68
How is the embryonic gut suspended?
All segments suspended by dorsal mesentery from dorsal body wall Foregut also suspended anteriorly by ventral mesentery
69
Where do the greater and lesser sacs develop from?
The foregut, split into right and left sacs by the dorsal and ventral mesenteries. Left becomes greater sac, right becomes lesser.
70
Describe how the stomach develops
Week 4 - foregut proliferates Week 5 - dorsal wall grows rapidly to form the greater curvature, bends tube ventrally (90 degrees) Week 7- dorsal mesentery grows, rotating 90 degrees laterally, pushes greater curvature left, lesser right.
71
Define a peritoneal reflection
A change in direction, lined by a single membrane
72
What seperates the developing GI and respiratory tracts?
Tracheoesophageal septum
73
Describe the development of the respiratory tract
Week 4, respiratory diverticulum forms in ventral wall of foregut, forming the respiratory primordium (ventrally) and oesophagus (dorsally)
74
What are the abnormalities in the tracheosophageal septum?
Proximal blind end- oesophagus | Tracheoesophageal fistula
75
What are the consequences of abnormal tracheoesophageal septum?
Food passing into lungs causing cyanosis and pneumonitis (lung inflammation) Air passing into stomach
76
What glands are foregut derived?
Liver and billary system - from ventral mesentery Pancreas - unicate process and inferior head from ventral Superior head, body and tail from dorsal
77
What are the peritoneal reflections of the liver?
Visceral peritoneum covers the visceral surface and anterior diaphragmatic surface. Posterior diaphragmatic surface has no peritoneal covering, in direct contact with diaphragm.
78
What are subphrenic recesses and where are they found?
Superior extensions of the peritoneal cavity between anterior and superior liver and diaphragm. Split into left and right recesses by falciform ligament, connecting liver to anterior abdominal wall
79
How does the development of the stomach cause the duodenum to become secondarily retroperitoneal?
Rotation of stomach

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