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Anatomy > Abdomen > Flashcards

Abdomen Flashcards

1
Q

surface landmarks of abdominal wall

A

-xiphoid stress
-xiphosternal joint
-costal margin- 7-10 (L3, rib 10, xiphoid process)- upper margin
-inguinal ligament and pelvic bones- lower margin
-iliac crest- across L4
-symphysis pubis
-inguinal canal
-linea alba- from pubic symphysis to xiphoid process- vertical fibrous band
-linea semilunaris- lateral borders of rectus abdominus (outer abs)
-tendinous intersections- defines 6 pac

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2
Q

iliac crest

A

-anterior superior iliac spine (ASIS)- iliac crest ends here anteriorly
-posterior superior iliac spine (PSIS)- ends here posteriorly
–> waist circumference

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3
Q

inguinal ligament

A

-rolled-under inferior margin of the aponeurosis of the external oblique muscle
-attached to the ASIS and pubic tubercle

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4
Q

superficial inguinal ring

A

-triangular aperture in the aponeurosis of the external oblique muscle
-situated above the medial to the pubic tubercle
-Inguinal hernia
-direct- directly through abdominal wall traverse superficial ring
-indirect- traverse deep and superficial inguinal rings
-if it is medial or lateral to inferior epigastric -> tell you if it is direct or indirect

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5
Q

vertical lines

A

-passes through the midpoint between the ASIS and symphysis pubis

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6
Q

transpyloric plane

A

-passes through the tips of the 9th costal cartilage @ L1
-pylorus of stomach, duodenum junction, neck of pancreas, and hilum of kidneys run through here

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7
Q

subcostal plane

A

-joins the 10th costal cartilage at level of L3

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8
Q

intertubercular plane

A

-joints the tubercles on the iliac crest at L5

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9
Q

contents of abdomen

A

-liver- under cover of lower ribs, most of it lies in RUQ (in thin adult, 2 fingerbreadth below costal margin)
-gallbladder- fundus lies opposite the tip of right 9th costal cartilage
-spleen- LUQ and lies under cover of 9-11 ribs (well protected)
-pancreas- lies across transpyloric plane (deep)
-kidneys- right is slightly lower than left (right palpable in right lumbar region at the end of deep inspiration
-duodenum- transpyloric plane about 4 fingerbreadths to right of midline (mostly retroperitoneal)
-cecum- RLQ
-appendix- RLQ, base is situated 1/3 up line, joining ASIS to umbilicus (McBurney’s point)
-ascending colon- extends upwards from cecum on lateral side of right vertical line (retroperitoneal)
-transverse colon- extends across abdomen, occupying umbilical region
-descending colon- extends downward from left costal margin on lateral side of left vertical line
-sigmoid colon- approx 10-15 inches and continuous with rectum in from of S3
-rectum- 5 inches and begins anterior to S3, pierces pelvic floor and becomes continuous with anal canal

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10
Q

stomach

A
  • cardioesophageal junction lies about 3 fingerbreadths below to left of xiphisternal junction, lesser curvature lies on curved lines joining the cardioesophageal junction and pylorus, greater curvature has extremely variable position in umbilical region or below
    -esophagus pierces the stomach at T10
    -pylorus lies in transpyloric plane
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11
Q

abdominal wall layers

A

-skin
-superficial fascia- campers -> yellowy/fatty (superficial), scarpa -> membranous (deep)
-investing fascia
-muscles
-extraperitoneal fat
-parietal peritoneum

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12
Q

paracolic gutters

A

-lateral and medial sides of ascending and descending colon
-site for fluid collection
-movement of infected peritoneal fluid

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13
Q

subphrenic space

A

-between the liver and diaphragm
-fluid can collect
-drain inferior to 12th rib

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14
Q

nerve supply- skin, muscles, and parietal peritoneum

A

-anterior rami of lower 6 thoracic and 1st lumbar nerves
-lower 5 intercostal and subcostal nerves
-iliohypogastric and ilioinguinal nerves
-run between internal oblique and transversus abdominus muscle
-lower 6 thoracic pierce rectus sheath
-iliohypogastric nerve pierces the external oblique aponeurosis above the superficial inguinal ring
-ilioinguinal nerve passes through the inguinal canal to emerge through the ring
-iliohypogastric and ilioinguinal-arise from anterior rami of L1

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15
Q

T7 dermatome

A

-epigastric around xiphoid process
-T10- umbilicus
-L1- just above inguinal ligament at the pubic symphysis
-T4 nipple

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16
Q

blood supply to abdominal wall

A

-midline- branches of superior (comes off internal thoracic) and inferior epigastric (comes off external iliac)
-flanks- intercostal, lumbar (come off aorta), and deep circumflex iliac (external iliac) arteries
-inguinal region- superficial epigastric, superficial circumflex iliac, superficial external pudendal (all originate from femoral artery

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17
Q

venous drainage

A

-same names as arteries
-drain into internal thoracic and external iliac veins, azygos, and inferior vena cava
-paraumbilical vein drains into porta vein

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18
Q

lymph drainage

A

-above umbilicus drains- anterior axillary lymph nodes
-below umbilicus- superficial inguinal nodes

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19
Q

caput medusae

A

-paraumbilical veins drain into porta veins
-if backup in portal system
-pressure increased
-veins distend in umbilical region
-stomach, esophagus, anal area -> same effect

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20
Q

superficial fasica

A

-superficial fatty layer (fascia of camper)- continuous

-deep membranous layer (scarpas fascia)- fades out laterally and above:
-inferiorly- fuse with deep fascia of the thigh (fascia lata)
-midline- forms tubular sheath for penis (clitoris)
-perineum- attached on each side to margins of the pubic arch (colles fascia)
-posteriorly- fuses with perineal body and posterior margin of the perineal membrane

-investing (deep) fascia- thin layer of areolar tissue covering the muscles

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21
Q

arcuate line

A

-marks the transition of the 3 abdominal muscles (sheath) running anteriorly to rectus abdominus at and below ASIS and the transversalis fascia covering the inferior quarter
-where arcuate line meet semilunaris -> area of herniation -> lateral ventral wall hernia -> spigelian hernia***
-hematomas can collect there post op bc there is no strong posterior fascia
-below arcuate line is weaker -> subpubic incision

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22
Q

rectus sheath

A

-formed by the aponeroses of the 3 lateral abdominal wall muscles: external and internal oblique and transversus
-above the ASIS- external oblique is above rectus, internal is above and below, and transversus runs below
-ASIS and below- all three run anterior to rectus abdominus -> no support below rectus other than the transversalis fascia
-rectus sheath looks thicker below ASIS

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23
Q

peritoneum and peritoneal cavity

A

-peritoneum is serous membrane that lines abdominal and pelvic cavities and that covers the viscera
-parietal layer lines the walls of abdominal and pelvic cavities
-visceral layer covers the organs
-potential space- peritoneal cavity
-peritoneum secretes fluid for lubrication of organs

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24
Q

2 parts of peritoneal cavity

A

-greater and lesser sac
-greater sac is main compartment- extends from diaphragm down into pelvis
-lesser sac- smaller and lies behind the stomach-> allows for stomach expansion with eating
-sacs are in free communication with one another through the epiploic foramen

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25
Q

folds

A

-on parietal peritoneum
-5 folds below umbilicus on anterior wall of greater sacs
-peritoneal fossa between the folds
-median umbilical fold- urachus- contains urinary bladder and fetus- extends from urinary bladder to umbilicus
-medial umbilical folds on both sides of median umbilical fold- contain a obliterated umbilical artery- extends from sides of bladder to umbilicus
-lateral umbilical folds- contain inferior epigastric artery- extends from deep inguinal ring to arcuate line
-hasselbalch (inguinal) triangle in the fossa between the medial and lateral folds -> rectus abdomnis (lateral), inferior epigastric (medial), and iliopubic tract (inferiorly)
-inguinal rings in the lateral fossa (most outer) -> potential sites of hernias

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26
Q

lesser sac

A

-lies behind the stomach and lesser omentum
-dips into the omentum layers
-extends upwards as far as the diaphragm and downward between the layers of the greater omentum
-left margin- spleen, gastrosplenic omentum, splenicorenal ligament
-right margin opens into greater sac (main part of peritoneal cavity) through the epiploic foramen
-formed due to 90 degree clockwise rotation of the stomach during development
-allows for stomach to expand after eating
-superior border is posterior to stomach on lesser omentum and less border is at the tip of greater omentum

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27
Q

boundaries of epiploic foramen

A

-the communication of the greater and lesser sac
-anteriorly- free border of lesser omentum, bile duct, hepatic artery, and portal vein -> portal triad
-posteriorly- inferior vena cava
-superiorly- caudate process of caudate lobe of liver
-inferiorly- first part of duodenum

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28
Q

peritoneal ligaments, omenta, and mesenteries

A

-permit blood, lymph vessels, and nerves to reach the viscera
-peritoneal ligaments:
-2 layers folds of peritoneum that connect solid viscera with the anterior abdominal wall (mesenteries is posterior)
-ie. falciform ligament (liver), coronary ligament (peritoneum/diaphragm), and right and left triangular ligaments
-round ligament- tethers liver to abdominal wall as well- contains ligamentum teres (obliterated umbilical vein) -> goes straight to umbilical

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29
Q

omenta

A

-viscera to viscera
-2 layered folds of peritoneum that connect the stomach with another viscus
-greater omentum- greater curvature of stomach with the transverse colon, spleen, and diaphragm, -> gastro-phrenic, gastro-splenic portion-colic portions
-lesser omentum- lesser curvature to the fissure for the ligamentum venosum and the porta hepatis of the liver -> hepato-gastric, duodenal
-ligamentum venosum- cord like lies within hepato-gastro ligament to liver -> between caudate lobe and left lobe of liver

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30
Q

liver

A

-bare side of liver without peritoneum
-allows for infection
-can spread to abdomen to thoracic cavity

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31
Q

porta hepatis

A

-on the underside of viscera of liver
-where hepatic veins enter and leave
-equivalent of a root of lung

32
Q

mesenteries

A

-2 layered fold of peritoneum connecting parts of the intestines with the posterior abdominal wall
-mesentery of small intestine
-transverse mesocolon
-sigmoid mesocolon

33
Q

nerve supply of peritoneum

A

-parietal peritoneum- very sensitive to pain, temp, touch, pressure -> lower 6 thoracic and 1st lumbar nerves
-parietal peritoneum- supplied by vicerator nerve
-visceral peritoneum- stretch, chemical irritation (ischemia) -> autonomic nerves that supply the viscera of that are traveling in mesenteries
-visceral is poorly localized
-ex. appendicitis- midline pain at first visceral pain fibers are unmyelinated, lateral, enter spinal cord at various levels -> as it worsens parietal peritoneum sharpens pain (somatic)

34
Q

retroperitoneal space

A

-not in the paritenal cavity
-lies on posterior abdominal wall behind parietal peritoneum
-extends from 12th thoracic vertebra and 12th rib to sacrum and iliac crests
-floor or posterior wall:
-formed medial to lateral by the psoas and quadratus lumborum muscles and the origin of the transversus abdominis muscle

35
Q

contents of retroperitoneal space

A

-variable amount of fatty connective tissue
-muscles are covered by fascia
-suprarenal glands
-kidneys
-ascending and descending colon
-duodenum- first inch is not
-pancreas
-ureters
-renal and gonadal blood vessels

36
Q

esophagus

A

-muscular tube about 10 in (25) long
-pharynx to stomach
-level of the cricoid cartilage in the neck and descend in midline behind trachea
-through mediastinum and enters the abdominal cavity by piercing the diaphragm at T10
-right and left vagus nerves come with it
-upper 1/3- skeletal muscle
-middle 1/3- skeletal and smooth
-distal 1/3- smooth
-constrictions- 5 sites: cricoid, aortic arch, carina, LA, esophageal hiatus

37
Q

sphincters of esophagus

A

-UES:
-skeletal
-opening: thyrohyoid and geniohyoid
-closing: inferior pharyngeal constrictor, cricophyrangeus (dont memorize)

-LES- smooth muscle

38
Q

esophageal fistula

A

-left principal bronchus crosses the anterior surface of the esophagus
-a fistula can form here (connection)
-occurs with lung cancer

39
Q

arterial/venous supply of esophagus

A

-cervical esophagus- inferior thyroid arteries and veins (not important)
-thoracic arterial- upper 2/3- descending thoracic aorta and lower* 1/3- L gastric artery
-thoracic venous- upper 2/3- azygos and lower 1/3 L gastric vein
-abdominal- left gastric artery and vein

-L gastric vein- drain into portal system if you have cirrhosis of liver -> back up of blood-> esophageal varices -> can hemorrhage* -> catastrophe

40
Q

diabetes / vagus nerve

A

-gastroparesis
-vagus nerve- parasympathetic
-diabetes can affect vagus nerve -> slows
-food sits long enough -> vomit or reflux

41
Q

nerve supply esophagus

A

-cervical- recurrent laryngeal (branch of vagus) and sympathetic trunk
-thoracic- vagus nerve and sympathetic trunk
-abdominal- vagus nerve and sympathetic trunk

-auerbachs (motility) and meissners plexus (mucus)

42
Q

stomach

A

-dilated portion of the GI tract
-situated in the upper part of abdomen
-J shaped
-2 openings, 2 curvatures, 2 surfaces
-lesser curvature- right border of stomach, connected to the liver by the lesser omentum
-greater curvature- left border, gastrosplenic omentum (ligament) connects to the spleen, greater omentum to the transverse colon
-cardiac orifice (physiologic- just a thickening) and pyloric sphincter (anatomic -> circular muscle and physiologic)
-cardiac orifice is aka lower esophageal sphincter

43
Q

stomach anatomy

A

-from top to bottom
-fundus
-body
-antrum
-pylorus
-longitudinal muscle coat, circular muscle coat, oblique muscle coat (allowed for churning)
-rugae- ridges-> allows for expansion

44
Q

arterial supply to stoamch

A

-celiac trunk gives off left gastric, hepatic, splenic arteries
-hepatic gives off right gastric (supplies lesser curvature) and anastomoses with left gastric artery
-splenic artery- gives off short gastric arteries and left gastroepiploic artery ( gastro-omental artery) anastomoses with right gastroepiploic artery which comes off of gastroduodenal artery
-gastroduodenal artery is a branch of hepatic
-left and right gastroepipiloic arteries -> give rise to gastro-omental which supply greater omentum

45
Q

venous drainage of stomach

A

-veins drain into portal circulation
-right/left gastric veins drain into portal vein
-short gastric and left gastroepiploic veins drain into splenic vein
-right gastroepiploic vein drains into superior mesenteric vein
-superior mesenteric and splenic vein -> portal vein

46
Q

stomach lymph

A

all lymph from stomach passes to celiac nodes

47
Q

nerve supply of stomach

A

-sympathetic -> T6-T9- sympathetic trunk from celiac plexus and greater splanchnic nerves
-parasympathetic -> vagus

48
Q

small intestine

A

-extends from pylorus of stomach to ileocecal junction
-divided into 3 parts- duodenum, jejunum, ileum

49
Q

duodenum

A

-C-shaped tube approx 10 in in length that curves around the head of pancreas
-begins at pyloric sphincter of stomach and it ends by becoming continuous with jejunum
-first inch of duodenum has lesser omentum attached (intraperitoneal) to upper border and greater omentum attached to lower border
-remained of duodenum is retroperitoneal

50
Q

part of duodenum

A

-1st- runs upward/backward on transpyloric plane at L1
-2nd part- runs vertically downward (bile and pancreatic ducts pierce medial wall)
-3rd part- passes horizontally in front of vertebral column
-4th- runs upward to left to duodenojejunal flexure
-flexure is held in position by ligament of treitz -> attached to right crus of diaphragm
-ligament of treitz separates upper and lower GI tract

51
Q

duodenum ducts

A

-major duodenal papilla receiving bile duct and main pancreatic duct sphincter of oddi
-ducts pierce medially

52
Q

duodenum arterial supply

A

-upper half superior pancreaticoduodenal artery (branch of gastroduodenal artery)
-lower half- inferior pancreaticoduodenal artery (branch of superior mesenteric artery)
-veins- superior pancreaticoduodenal vein joins the portal vein /// inferior pancreaticoduodenal vein joins the superior mesenteric vein
-everything drains into portal system

53
Q

nerve supply duodenum

A

-sympathetic (greater and lesser splanchnic nerves) and vagus nerves via celiac and superior mesenteric plexuses

54
Q

jejunum

A

-8ft long
-begins at the duodenojejunal flexure in the upper part of the abdominal cavity and to the left of the midline
-wider, thicker, redder (more vascular) than ileum
-very strong mesentery attaches both to posterior abdominal wall

55
Q

ileum

A

-12 ft
-coils of the ileum occupy the lower right part of the abdominal cavity
-ends at ileocecal junction
-very strong mesentery attaches both to posterior abdominal wall

56
Q

arterial and venous supply from jejunum and ileum

A

-very rich arterial supply
-arteries- branches of superior mesenteric artery
-veins- drain into superior mesenteric vein
-lymph- intermediate nodes to SMA nodes
-longer (less arterial arcades) vasa recta in jejunum
-shorter (more arterial arcades) vasa recta in ileum
-vasa recta are in circular muscles of bowel

57
Q

large intestine

A

-ileocecal valve to the anus
-divided into cecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anal canal

58
Q

cecum

A

-blind ended pouch within the right iliac fossa
-no mesentary
-completely covered with peritoneum
-at junction of cecum and ascending colon -> joined on left side by terminal part of ileum -> ileocecal valves enters
-appendix attached to posteromedial surface

59
Q

teniae coli

A

-longitudinal

60
Q

cecum arterial and venous supply

A

-anterior and posterior cecal arteries from ileocolic artery- branch of SMA
-veins- ileocolic vein
-lymph- mesenteric and superior mesenteric nodes
-nerve- sympathetic and vagus via superior mesenteric plexus

61
Q

appendix

A

-narrow
-muscular tube
-attached to posteromedial surface of cecum
-complete peritoneal covering which is attached to the mesentery of small intestine by short mesentery
-mesoappendix contains appendicular vessels and nerves

-appendicular artery and vein
-lymph- nodes of mesoappendix -> superior mesenteric nodes
-nerve- sympathetic and vagus nerves from superior mesenteric plexus

62
Q

ascending colon

A

-5 inch
-peritoneum covers front and sides and bind it to posterior abdominal wall
-lies posteriorly on iliacus, quadratus lumborum, and lower pole of the right kidney

63
Q

ascending colon arterial and venous

A

-artery- ileocolic and right colic branches of SMA
-veins- ileocolic and right colic branches of SMV
-lymph- colic and superior mesenteric
-nerve- sympathetic and vagus from superior mesenteric plexus

64
Q

transverse colon

A

-approx 15 inch
-occupies umbilical and hypogastric regions
-contains transverse mesocolon
-phrenocolic ligament on left -> fold of peritoneum -> tethers onto diaphragm
-most mobile

65
Q

transverse colon artery and venous

A

-artery:
-proximal 2/3- middle colic artery
-distal 1/3- left colic artery
-marginal artery anastomoses inferior and superior mesenteric supply
-vein:
-proximal 2/3- middle colic vein
-distal 1/3- left colic vein
-lymph- prox- superior mesenteric nodes; distal inferior mesenteric nodes
-nerve supply- prox 2/3- sympathetic and vagus; distal 1/3- sympathetic and parasympathetic pelvic splanchnic nerves through the inferior mesenteric plexus***

66
Q

descending colon

A

-approx 10 inch
-peritoneum covers front and sides and also binds it to posterior abdominal wall
-lies posteriorly on left kidney the quadratus lumborum, and iliacus muscles

67
Q

descending colon arteries and veins

A

-arteries- left colic and sigmoid artery
-veins- left colic and sigmoid vein
-lymph- colic and inferior mesenteric nodes
-nerve- sympathetic and parasympathetic pelvic splanchnic nerves via inferior mesenteric plexus

68
Q

sigmiod colon

A

-approx 10-15 in
-continuous with rectum in front of S3 vertebra
-attached to posterior pelvic wall by fanshaped sigmoid mesocolon
-supplied by sigmoid artery and veins
-lymph- colic and inferior mesenteric nodes
-nerve- sympathetic and parasympathetic nerves -> pelvic splanchnic nerves

69
Q

rectum

A

-about 5 inch long and begins anterior to 3rd sacral vertebrae
-pierces the pelvic floor and becomes continuous with anal canal
-peritoneum covers portion of upper 2/3rds of rectum
-teniae coli form longitudinal broad band on anterior and posterior surface of rectum (covers the whole thing bc increased pressure)

70
Q

incontinence

A

-anal rectal flexor- maintained by contraction of puborectalis muscle
-weakening -> 80 angle changes -> incontinence
-valves of Houston (transverse folds)- hold stool up
-internal (involuntary) and external (voluntary) sphincter

71
Q

arterial and venous supply to rectum

A

-arteries:
-superior rectal artery (branch of IMA)
-middle rectal arteries (branch of internal iliac artery)
-inferior rectal artery (internal pudendal artery)
-veins:
-superior rectal vein (IMV) -> into portal circulation** -> back up in portal > dilated veins in rectum -> not hemorrhoids* -> can bleed
-middle-> internal iliac vein
-inferior rectal vein -> internal pudendal vein
-nerve- sympathetic and parasympathetic pelvic splanchnic nerves

72
Q

anal canal

A

-about 1 1/2 in
-pectinate line*- divides into lower/upper halves
-above line- involuntary internal sphincter -> parasymp and symp -> only sensitive to stretch (No pain) bc its part of visceral system
-below- voluntary external sphincter -> somatic motor (pain, temp, pressure,)
-blood supply- superior/inferior rectal artery and vein

73
Q

liver developmental ligaments

A

-ligamentum venosum is remnant of ductus venosus- shunted blood from umbilical vein to IVC -> short circuiting the liver
-round ligament - remnant of obliterated umbilical vein which carried oxygenated blood from placenta to fetus
-fetal blood bypass liver via ductus venosus and enter IVC
-ductus arteriosum-> ligamentum arteriosum

74
Q

abdomen supply

A

-foregut- above ligament of treitz - celiac trunk
-midgut- before transverse colon - superior mesenteric
-hindgut- after transverse colon- inferior mesenteric

75
Q

absorbtion

A

-duodenum- iron
-ileum- B12, bile salts

76
Q

3 anterior visceral branches

A

-celiac artery-> left gastric, splenic, hepatic arteries
-splenic artery-> short gastric (6), splenic (6), left gastroepiploic
-hepatic artery-> cystic, right gastric, gastroduodenal, right hepatic, left hepatic
-refer to slide/image

77
Q
A

Anatomy (34 decks)

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