Abdomen Flashcards
List the nine regions of the abdomen
Going superoinferiorly:
- Right and left hypochondriac, and epigastic
- right and left lumbar regions* *, umbilical
- right and left iliac or inguinal, hypogastric/pubic
Hector {} isabel every unceasing hour
Hypogastric = pubic, iliac = inguinal
NOTE: lumbar is superior to iliac/inguinal
NOTE 2: umbilicus at level of L3/4* *, can be used to divide left right upper lower quadrants
NOTE 3: abdominal cavity bordered superiorly by diaphargm(extends up to 4th intercostal space), continous with pelvic, hence “abdominpelvic”
What could be sources of pain in the epigastric region?
- could be originating from abdominal cavity organs, muscles, or further posterior i.e. retroperitoneal (oesophagus, reflux)
Examples of DDx for reflux or GERD
- heart burn
- ‘stitch’ or muscle pain
- peptic ulcer/stomach pain
What could be sources of pain in hypogastric region?
- Bladder pain
-uti
-diverticulitis
-apendicitis
What could be sources of pain in right iliac region?
- appendicitis ^[1]
- reproductive organs in female (ovary, fallopian tubes) ^[2]
1- unless situs inversus
2- if reproductive in origin would expect pain on contralateral side
Describe the divisions of the abdominal cavity
The abdominal cavity is one of three ventral body cavities.
It is located between the diaphragm and pelvic inlet or brim.
The dome shaped diaphragm forms the roof, thus the abdominal cavity extends into the thoracic space, up to the 4th intercostal space.
The abdominal cavity does not have a floor.
The abdominal cavity is continuous with the pelvic cavity below it, at the pelvic brim. THe combined space is sometimes referred to as the abdominpelvic cavity.
The abdominal wall is supporting by the greater pelvis, and also receives support posteriorly from the lumbar verterbrae, and it is surrounded by the abdominal wall.
Muscles are the mainstay of the abdominal wall.
The abdominal cavity contains most digestive organs, spleen, adrenal glands, kidneys and ureters.
There are nine regions and four quadrants of the abdomen:
Describe the contents of the regions of the abdominal cavity
- right hypochondriac:
The liver
The gallbladder
The small intestine
The ascending colon
The transverse colon
The right kidney - epigastric: stomach liver pancreas dudoenum spleen adrenal glands
The esophagus
The stomach
The liver
The spleen
The pancreas
The right and left kidneys
The right and left ureters
The right and left suprarenal glands
The small intestine
The transverse colon - left hypochondriac:
The stomach
The top of the left lobe of the liver
The left kidney
The spleen
The tail of the pancreas
Parts of the small intestine
The transverse colon
The descending colon - right lumbar
The tip of the liver
The gallbladder
The small intestine
The ascending colon
The right kidney - umbilicalThe stomach
The pancreas
The small intestine
The transverse colon
The medial extremities of right and left kidneys
The right and left ureters
The cisterna chyli - left lumbar
A portion of the small intestine
A part of the descending colon
The tip of the left kidney - right iliac
The small intestine
The appendix
The cecum
The ascending colon
The right ovary and right fallopian tube in females. - hypogastric or suprapubic
The small intestine
The sigmoid colon
The rectum
The urinary bladder
The right and left ureters
The uterus, the right and left ovaries and the fallopian tubes can be found in females
The ductus deferens, seminal vesicles and prostate in males - left iliac
Part of the small intestine
The descending colon
The sigmoid colon
The left ovary and the left fallopian tube in females.
Describe the contents of the quadrants of the abdominal cavity
RUQ: liver right lobe, gallbladder, pylorus of stomach, right colic or hepatic flexure, duodenum, head of pancreas, right adrenal gland, right kidney, ascending colon, R transverse colon
LUQ:liver left lobe, spleen, stomach, jejunum and ileum, L colic or hepatic flexure, body or tail of pancreas, left adrenal gland and left kidney, L transverse colon, descending superior colon
RLQ: caecum, appendix, ileum, ascending inferior colon, R ovary, R uterine canal, ureter R, uterus, urinary bladder, R spermatic cord
LLQ: urinary bladder, L uterine canal, uterus, L spermatic cord, descending inferior colon, L ovary, ureter L
SEE ALSO radiopedia surfaca anatomy diagram
Describe the divisions of the gastrointestinal tract
The gastrointestinal tract, also known as the digestive tract, can be divided into three main regions based on embryological origin: the foregut, midgut, and hindgut.
Foregut: The foregut encompasses the upper part of the gastrointestinal tract and includes the mouth, pharynx, esophagus, stomach, and the first part of the duodenum.
Midgut: The midgut is the middle portion of the gastrointestinal tract and includes the remaining parts of the small intestine (distals 2/3s of duodenum, jejunum and ileum) and the first two-thirds of the large intestine (cecum, appendix and ascending colon, proximal 1/3 transverse colon).
Hindgut: The hindgut comprises the remaining parts of the large intestine, including the transverse colon, descending colon, sigmoid colon, rectum, and anus.
Which is higher, the right or left dome of the diaphragm?
Right dome is higher, i.e. more superior, in order to accommodate the liver.
Which is higher, the right or left kidney?
The left kidney sits higher i.e. more superior than the right, as the right kidney sits inferior to the right lobe of the liver
List the surface anatomy features of the abdomen
- vertical: midclavicular tom id inguinal, lateral to 9th costal cartilage tip (marks costal margin)
- subcotal lae: joinig lower most bonty points of rib cage usually between 10 cotal cartilage
- umbilicus: L3/4: abdominal aorta branches at L4; common hernia site; enter perinuem for laparoscopy– identify problems
- transtubercukar: joining two tubercles or iliac crest, L5 - iliac veins confluence
- linea alba: cut no innervation, access abdomen in surgery
- pubic tubercle
- pubic sympysis
List and briefly describe the layers of the abdominal wall
- skin
- subcutaneous fat
- superficial fascia: fatty and fibrous layers
- rectus abdominis (and sometimes pyramidalis) (surrounded by rectus sheath, formed by aponeuroses of transverus abdominis, external and internal obliques)
- external oblique
- internal oblique
- transcerus abdominis
- transversalis fascia (and extraperitoneal fat)– retroperitoneal organs located here
- parietal peritoneum (perceptible, shiny)
- visceral peritoneum (1 cell layer thick, imperceptible)
Describe the organisation of the peritoneum - parietal/visceral
Parietal peritoneum first, shiny, perceptible; folds (Reflections = visceral peritoneum second ( 1 cell layer thick, imperceptible)
Describe anatomy of liver
right left, caudate (which is superior to ), quadrate lobe; ligaments: right and left coronary ligs, triangular hold liver in place, continuations of coronary, flciform anchors ant abdo wall and diaph, teres – round ligament, remnant of umbilical vein; lesser omentum.; lig venosum remnant of ductum venosum
Describe the blood supply of the liver
see portal triad (hepatic portal vein, haptic artery, hepatic duct); also has hepatic vein
Describe the anatomy of the biliary system/tree
- hepatocytes
- biliary canaliculi c(commences at level, dilated space between hepatocytes adjacent) – coalesce to form
- interlobal canals, link up to form
- right and left hepatic ducts
- common heaptic ducy
- links with cystic duct to form common bile duct
- links for a brief stretch with pancreatic duct to form ampulla of Vater
- end, sphicter of Oddi, enters duodenum via greater dudoneal papilla
aim: intraheppatic biliary tract designed to transport bile from hepatocutes to extrahepatic biliary tree
aalso lesser duodenal papilla, receives from accesssory pancreatic duct
Describe the location and the morphology of the pancreas
Head body and tail
Head in RUQ, body and tail in LUQ
Summarise the structure of the stomach
Pylorus in RUQ
Define duodenum, jejunum and ileum
The small intestine is divided into the duodenum, jejunum, and ileum. Together these can extend up to six meters in length. All three parts are covered with the greater omentum anteriorly. The duodenum has both intraperitoneal and retroperitoneal parts, while the jejunum and ileum are entirely intraperitoneal organs.
Duodenum: extends from the pyloric sphincter of the stomach, wraps around the head of the pancreas in a C-shape and ends at duodenojejunal flexure. This flexure is attached to the posterior abdominal wall by a peritoneal fold called the suspensory muscle (ligament) of duodenum, also called the ligament of Treitz.
superior (duodenal bulb/ampulla), descending, horizontal and ascending. Among several features of the duodenum, we’ll list the two most important:
The superior part (duodenal bulb/ampulla) is the only intraperitoneal part, as the hepatoduodenal ligament and greater omentum attach to it. The descending part of the duodenum has an opening called the major duodenal papilla (tubercle of Vater). The papilla contains the hepatopancreatic sphincter (sphincter of Oddi, Glissons’ sphincter) which regulates the emptying of the bile from the hepatopancreatic ampulla.
Jejunum:
The jejunum is the second part of the small intestine. It begins at the duodenojejunal flexure and is found in the upper left quadrant of the abdomen. The jejunum is entirely intraperitoneal as the mesentery proper attaches it to the posterior abdominal wall.
There is no clear line of demarcation between the jejunum and ileum, but there are some anatomical and histological differences
The ileum is the last and longest part of the small intestine. It is found in the lower right quadrant of the abdomen, although the terminal ileum can extend into the pelvic cavity. The ileum terminates at the ileal orifice (ileocecal junction) where the cecum of the large intestine begins.
Arteries: celiac trunk, superior mesenteric artery
Veins: hepatic portal vein, superior mesenteric vein
Innervation
Parasympathetic: vagus nerve (CN X) (through the submucosal (Meissner’s) and myenteric (Auerbach’s) nervous plexuses)
Sympathetic: Thoracic splanchnic nerves
Differentiate between the duodenum, jejunum, and ileumm function
The main functions of the small intestine are secretion and absorption. The epithelial cells of the small intestine secrete enzymes which digest chyme into the smallest particles, making them available for absorption. Concurrently the duodenum functions to mix food with bile and pancreatic enzymes to continue the digestion of carbohydrates, fats, and proteins.
Concerning absorption, carbohydrates and proteins are absorbed in the duodenum and jejunum respectively. The jejunum also functions to absorb most fats. The ileum function involves absorption of vitamin B12, bile salts and all digestion products which were not absorbed in duodenum and jejunum. All three small intestine segments absorb water and electrolytes.