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Medicine > Abdomen > Flashcards

Abdomen Flashcards

1
Q

How many regions and quadrants can the abdomen be divided into?

A

9 regions
4 quadrants

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2
Q

What is the pubic symphysis?

A

This is formed by the articulation between the left and right pubic bones. It is a joint.

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3
Q

What are a few examples of organs in the peritoneum?

A

Stomach, Spleen and Liver

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4
Q

What is the peritoneal cavity?

A

Between the Visceral peritoneum and parietal peritoneum. Contains peritoneal fluid which allows the movement of fluid during digestion.

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5
Q

What does intraperitoneal mean?

A

This means organs are almost completely covered with the visceral peritoneum (e.g. liver and stomach)

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6
Q

What does extraperitoneal, retroperitoneal and sub peritoneal mean?

A

Retroperitoneal= the space behind the peritoneum. These organs are partially covered by the peritoneum with just a layer of parietal peritoneum (e.g. where kidneys are)
Sub peritoneal= the space inferior (below) the peritoneum (e.g. bladder)
Extraperitoneal= outside the peritoneal.

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7
Q

How many parts are there to the peritoneal? What are they called?
How can the 2 parts communicate with each other?

A

2.
Greater and lesser sac.
Via the epiploic foramen.

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8
Q

What is the dorsal and ventral mesogastrium? What structures develop in each?

A

These are the two channels that open to the Stomach within the peritoneum.
Dorsal = back (spleen is here)
Ventral = front (liver is here)

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9
Q

What are the 3 parts of the gut? What is the blood supply for each?

A

Foregut (Coeliac trunk- T12), Midgut- from 2nd part of the duodenum to proximal 2/3 of the transverse colon (Superior mesenteric artery- arises from L1) and Hindgut- from the distal 1/3 of the transverse colon to the rectum (Inferior mesenteric artery- arises from L3)

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10
Q

What ligament is the inguinal canal on top of?

A

Inguinal ligament

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11
Q

What are the roles of the abdominal muscles?

A

Protect the viscera
Assist in breathing
For Coughing and vomiting
Assist in defecation, urination and giving birth (by increasing the pressure in the thorax)

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12
Q

What is the linear alba?

A

White line running down the centre of the abdominal muscles. Formed by the aponeuroses of the 3 side abdominal muscles that join together at the midline (the 3 side abdominal muscles enclose the upper 3/4 of the rectus sheath and in the lower 1/4 only the anterior surface of the rectus abdominis muscle). It also separates the two sides of the rectus abdominis muscle.

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13
Q

What are the horizontal lines between rectus abdominis muscles?

A

They are called tendinous intersections (visible if you have a 6 pack)

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14
Q

What is the pyramidalis?

A

A small triangular muscle located just below the rectus abdominis and forms part of the rectus sheath

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15
Q

What are the 3 side abdominal muscles? What direction to they go?

A

External oblique- Downwards and towards the midline (hands in pockets)
Internal oblique- Pass upwards and towards the middle (hands on tits)
Transverse abdominis- Fibres run horizontally

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16
Q

What does it mean saying the internal oblique splits into 2 layers?

A

For the top 3/4 of the rectus sheath, the internal oblique splits into 2 layers to enclose the rectus abdominis muscles on their anterior and posterior surfaces.

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17
Q

What is an aponeurosis?

A

A broad flat tendon

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18
Q

What does the inguinal ligament stretch between?

A

ASIS- Anterior superior iliac spine (Top)
Pubic tubercle

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19
Q

What is meant by the arcuate line?

A

This line divides the rectus sheath into the upper 3/4 and lower 1/4 of the abdominal muscles. (Upper 3/4 is surrounded entirely by muscle while the lower 1/4 is only surrounded anteriorly)

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20
Q

What canal do the testes travel down to get to the scrotum?

A

The inguinal canal

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21
Q

What does the cremaster muscle do?

A

Found only in males and it covers the testes. It raises and lowers the testes in response to changes in temperature.

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22
Q

What is an inguinal hernia?

A

A protrusion of the parietal peritoneum and viscera through a normal or abnormal opening. Can be direct or indirect.

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23
Q

What is Hesselbach’s triangle?

A

This is a potential area of weakness in the abdominal wall through which a hernia can protrude

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24
Q

What is the difference between a direct and indirect hernia?

A

Direct hernia passes through Hesselback’s triangle while indirect does not. Indirect hernia is where there is a protrusion into the inguinal canal (usually happens before it closes once testes have fully descended into the scrotum during puberty)

Direct hernias occur medial to the inferior epigastric artery while indirect hernias occur lateral to the inferior epigastric artery.

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25
Q

What is a Mesentary?

A

This is a fold in the peritoneum that creates a channel to an intraperitoneal organ

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26
Q

What is meant by secondary retroperitoneal?

A

It originally had a mesentery and was intraperitoneal but this mesentery has now collapsed and it is secondary retroperiotneal.

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27
Q

What artery supplies the foregut?

A

Coeliac Trunk

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28
Q

How many main branches does the coeliac trunk divide into? What are they called?

A

3 main branches- Left Gastric, Splenic and the common hepatic

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29
Q

What is the Camper’s fascia and the Scarpa’s Fascia?

A

These two layers lie below the skin and above the external oblique muscles. The Camper’s fascia is a large fatty layer that sits directly below the skin and the Scarpa’s fascia is directly below it (thinner layer)

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30
Q

What is the deep and superficial inguinal ring?

A

The superficial inguinal ring is the entrance to the inguinal canal which is nearest to the pubic tubercle while the deep inguinal ring is the other entrance and is just above the midpoint of the inguinal ligament.

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31
Q

What is the omentum?

A

Greater and lesser omentum. They are folds in the peritoneal layer of the abdomen which relate to the stomach. The greater omentum is the large fold below it that creates 4 layers (connects greater curvature of the stomach to the transverse colon) while the lesser omentum is the smaller fold above it that is just 2 layers thick (connects lesser curvature of the stomach to the duodenum of the liver)

It prevents the visceral and parietal layers of the peritoneum from sticking to each other

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32
Q

What is the pylorus?

A

This is the exit tube out of the stomach which leads to the first part of the small intestine (the duodenum)

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33
Q

What is the fundus of the stomach?

A

The dome shaped part of the stomach at the top.

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34
Q

What is the falciform ligament?

A

It is the line running down the centre of the liver that connects the liver to the anterior abdomen wall

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35
Q

What is the portal triad?

A

Made up of the Bile duct (front right), Hepatic artery (front left) and Portal Vein (Posterior)

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36
Q

What are the 3 openings of the diaphragm and at what vertebrae level do they fall at?

A

Caval Opening (T8), Oesophageal opening (T10), Aorta (T12)

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37
Q

What is the function of the mesocolon?

A

Connects the transverse mesocolon of the large intestine to the posterior abdominal wall

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38
Q

How is a hepatic portal system different to normal circulation?

A

A Hepatic portal system has 2 capillary beds while normal circulation has 1 capillary bed

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39
Q

What is the Portal Vein? Does it contain valves?

A

The Portal Vein is a vein that drains blood from organs in the abdomen into the bottom of the liver.

No valves so blood flow can be in any direction depending on pressure gradient.

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40
Q

What does it mean if an organ has both portal and caval drainage?

What abdominal organs have both portal and caval drainage?

A

It means its can drain blood via veins through the portal venous system and the caval drainage system.
The portal vein brings 75-80% of the blood to the liver while the hepatic artery accounts for 20-25% of the blood. The portal vein has reduced oxygenation but is rich in nutrients from the intestines. The hepatic artery supplies oxygenated blood

Distal Oesophagus, Rectum and Anterior abdominal wall (Umbillicus)

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41
Q

What happens to the oesophagus caval veins if there is a block in the portal system?

A

Backflow of blood in the portal system results in a much higher volume of blood in the caval system which can cause them to swell (they become abnormally dilated- oesophageal varices) and burst

42
Q

What are the 3 parts of the small intestine?

A

Duodenum, jejunum and Ileum

43
Q

What artery supplies the small intestine?

A

Superior mesenteric artery

44
Q

How can you distinguish between the jejunum and the ileum?

A

Jejunum is a deeper red as it has greater vascularity
I is longer than J
J is wider than I
In J Arcades are large loops compared to many short irregular loops in I
Vasa recta are longer in J and shorter in I
J has a larger lumen
J has thicker walls
J is superior to I
I has a more fatty mesentery than J

45
Q

What is the caecum?

A

The next part of the intestine after the Ileum. The start of the small intestine. The appendix is attached to it.

46
Q

What are the 4 parts of the colon called?

A

Ascending colon, transverse colon, descending colon and sigmoid colon

47
Q

What structures follow the sigmoid colon?

A

Rectum and Anus

48
Q

What are taenia coli?

A

The 3 bands of longitudinal muscle on the colon

49
Q

What is one way to identify the colon?

A

Due to appendices epiploicae on the colon which are fatty tags that attach to the taenia coli

50
Q

Why is the large intestine pulled inwards to form saculations?

A

As the taenia coli is slightly shorter than the colon so it contracts inwards. These are called Haustra and look like pouches.

51
Q

What is the ligamentum teres?

A

This is the round ligament of the liver at the base of the falciform ligament which was originally attached to the left umbilical vein during foetal development.

52
Q

What is the role of the ligamentum venosum?

A

It is the remains of the ductus venosus which shunted blood from the umbilical vein to the inferior vena cava during foetal development

53
Q

What is the hilum of the liver called?

A

Porta hepatis

54
Q

What are the two top and bottom lobes of the liver called?

A

Top= Caudate lobe
Bottom = quadrate lobe

55
Q

What is the bare area of the liver?

A

This is the top of the liver between the two coronary ligaments which is in direct contract with the diaphragm (no peritoneal contact)

56
Q

What are the two points where the coronary ligaments from either surface of the liver join called?

A

Right and left triangular ligaments

57
Q

What is the surface marking for the gallbladder?

A

at the 9th costal cartilage on the mid-clavicular line

58
Q

What is the hepatopancreatic sphincter of Oddi?

A

This is a valve between the bile duct (and pancreatic duct) and the second part of the duodenum which regulates the flow of bile and pancreatic substrances into the duodenum.

59
Q

What is the hepatopancreatic ampulla (of Vatar)?

A

This is a spherical structure located at the site of the common bile duct and pancreatic duct and it marks where these 2 ducts join the second part of the duodenum.

60
Q

How many parts of the duodenum are there? Where are they found in relation to the peritoneum?
What are the parts called?

A

4- first is intra-peritoneal and the rest is retroperitoneal

1st- Superior
2nd- Descending
3rd- Inferior
4th- Ascending

61
Q

What is an accessory spleen?

A

when splenic tissue is scattered resulting in more than one spleen

62
Q

What is the start and end of the jejunum and ileum?

A

Start is the duodenojejunal flexure and end is he ileocecal junction.

There is no separation between the jejunum and ileum

63
Q

What are plicae circulares? Is there more in the Jejunum or ileum?

A

They are circular folds in the small intestine which increase the surface area for more absorption.
More densely packed in the jejunum as more absorption of digested substances occurs here.

64
Q

What are the 2 turns in the large intestine called?

A

Hepatic flexure = turn below the liver
Splenic flexure = turn below the spleen

65
Q

What is Mcburney point?

A

This corresponds to the lateral 1/3 on the line from the ASIS to the umbilicus and is the point where the base of the appendix is.

66
Q

What are hepatic veins?

A

Drain blood from the liver to the Inferior vena cava. They are not the same as portal veins which drain blood into the liver.

67
Q

What are tributaries?

A

A smaller branch of vein that drains into a larger vein

68
Q

What are rugae of the stomach?

A

These are ridges in the stomach that increase the surface area and stretch out to increase stomach volume when the stomach is full

69
Q

What is the pampiniform plexus?

A

It is a group of veins that drain the testes

70
Q

What is the linear semilunaris?

A

This is the outside lines of the rectus sheath that run Parallel to the linear alba (central line of the rectus sheath)

71
Q

What is the greater curvature of the stomach attached to?

A

The two layers of the greater omentum

72
Q

What do the gonadal arteries supply?

A

Testes in Men
Ovaries in Female

They start surprisingly high up (near the kidneys) due to where they originated from in early fetal life

73
Q

What is the Cardia of the stomach?

A

This is the area where the oesophagus joins the stomach

74
Q

What is the function of the oesophageal sphincter?

What vertebral level is it found at?

A

Sphincter is relaxed to allow food to enter the stomach
At rest, its function is to prevent the reflux of acid gastric contents into the oesophagus.

T11 vertebrae (oesophagus runs from the C6 to the T11)

75
Q

What is the pyloric sphincter?

A

This is the muscular valve that controls the passage of stomach contents into the duodenum

76
Q

What are the 3 ducts that form part of the biliary tree?

A

Common hepatic duct- takes bile from the liver to the Cystic Duct
Cystic duct- branch that takes liver to the gallbladder and back
Common bile duct- takes liver to the pancreas

77
Q

Is the jejunum and ileum intra or retroperitoneal?

A

Intraperitoneal

78
Q

Where do the kidneys lie in relation to the peritoneum?

A

Retroperitoneal

79
Q

Which kidney is lower and why?

A

Right is lower due to position of the liver that pushes it down.

80
Q

What layer of the anterior abdominal wall is the superficial inguinal ring found?

A

The external oblique

81
Q

What layer of the anterior abdominal wall is the deep inguinal ring found?

A

Transversalis fascia

82
Q

What are the 5 muscles of the posterior abdominal wall?

A

Psoas major, psoas minor, iliacus, quadratus lumborum, diaphragm

83
Q

What is the ilipsoas?

A

Flexes the thigh at the hip joint. Made up of the iliacus and the psoas major. Both combine and attach to the lesser trochanter of the femur

84
Q

What are the crura?

A

These are the two ‘legs’ of the diaphragm muscle that attach it to the vertebrae

85
Q

What vertebral levels are the caval, oesophageal and aortic openings in the diaphragm?

A

Caval- T8
Oesophageal- T10
Aortic- T12

86
Q

What arteries supply the adrenal gland?

A

Inferior phrenic artery (superior suprarenal)
Abdominal aorta (middle suprarenal)
Renal artery (inferior suprarenal)

87
Q

What position are the kidneys relative to the peritoneum and vertebrae?

A

Retroperitoneal
T12-L3

88
Q

What structure does the renal pelvis become?

A

The ureter

89
Q

What is a minor and major calyx?

A

A minor calyx surrounds the renal papillae of each pyramid and collects urine. Multiple minor calyces join to form a major calyx. Multiple major calyces join to form the renal pelvis which then becomes the ureter.

90
Q

Where is the ureter in relation to the peritoneum?
What does the ureter connect?

A

retroperitoneal
Kidney to Bladder

90
Q

Where are the potential points of obstruction for ureteric stones in the ureter?

A

Site 1- At the junction of the renal pelvis and the ureter
Site 2- Where the ureter crosses the pelvic brim
Site 3- During passage through the wall of the urinary bladder

90
Q

How is the arrangement of the left and right gonodal veins and suprarenal different?

A

The left suprarenal and gonodal veins drain into the left renal vein while the right ones drain directly into the inferior vena cava.

91
Q

What is a varicocele?
Why is the left side more suceptible?

A

This is when veins around the scrotum become enlarged and dilated and can swell.
This is because the left side enters at a right angle to the left renal vein while the right side enters the IVC directly at an acute angle so it is more favourable for slow. Therefore, varicoceles are more common on the left side.

92
Q

What are the 2 lymphatic drainage ducts of the body?

A

Right upper quadrant- Right lymphatic duct
Rest of the body- Thoracic duct

93
Q

Where does the thoracic duct and right lymphatic duct empty into the veins?

A

Between the left internal jugular vein and left subclavian vein.
The right lymphatic duct is the same except it is the equivalent right sided veins.

94
Q

What is the obturator nerve?

A

(L2-L4) Emerges from the medial border of psoas major and passes through the pelvis to supply the adductor muscles

95
Q

What is the genitofemoral nerve?

A

This nerve runs anterior to the psoas major and supplies the genital region (skin of scrotum for example) and parts of the thigh

96
Q

What is the gubernaculum?

A

A tissue that pulls the testis through the abdomen, through the inguinal canal, and down into the scrotum

97
Q

What is the tunica vaginalis?

What is the processes vaginalis?

A

This is a sac that lines the inside of the scrotum and was originally a small layer of parietal peritoneum before the descent of the testis.

The processes vaginalis is a section of the peritoneum that bulges through the inguinal canal and into the scrotum and then descends into it. The testis then descend into this pouch formed by the processes vaginalis and then the tube should be obliterated in order to prevent a indirect inguinal hernia.

98
Q

What veins join to form the portal vein?

A

Splenic vein and superior mesenteric vein

Medicine (42 decks)

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