Flashcards in Abdomen 2015 Deck (61)
Which intercostal space marks the superior border of the abdominal cavity?
4th intercostal space
At what vertebral and CC level does the transpyloric plane exist?
Posterior lower border of L1, and anteriorly to the tip of the 9th CC.
Which structures does the transpyloric plane transect (7)?
1.) the fundus of the gallbladder
2.) neck of the pancreas
3-4.) origins of the superior mesenteric artery (SMA) and hepatic portal vein
5.) root of the transverse mesocolon
6.) duodenojejunal junction
7.) hila of the kidneys.
What other pelvic/spinal landmark lies at the same level as the ASIS?
Describe the location of the renal angle in terms of ribs. What does it overlie?
-Renal angle lies between 12th rib and lateral margin of erector spinae.
-It overlies the lower part of the kidney.
"Renal angle: An area located on either side of the human back between the lateral borders of the erector spinae muscles and inferior borders of the twelfth rib, so called because the kidney can be felt at this location." -Wiki
Between which two vertebral levels does the umbilicus lie?
What is this demarcation called and what does it demarcate?
-L3 and L4
-Transumbilical line; divides abdomen into upper and lower halves.
#6, p.184 Moore
Superior to the costal margin, the rectus abdominis lies directly on ____________.
the thoracic wall
All layers of the anterolateral abdominal wall fuse at the ________.
Between which muscle layers does the abdominal neurovascular plane lie?
between the internal oblique and the transversus abdominis muscles
Describe the pattern of innervation for the anterior abdominal branches of thoraco-abdominal nerves T7-L1
• T7–T9 supply the skin superior to the umbilicus.
• T10 supplies the skin around the umbilicus.
• T11, plus the cutaneous branches of the subcostal (T12),
iliohypogastric, and ilio-inguinal (L1), supply the skin inferior to the umbilicus (1 in above the superior inguinal ring).
Where, and from what does the inferior epigastric artery arise?
Arises from the external iliac artery just superior to the inguinal ligament.
The inguinal ligament is a dense band constituting the inferior-most part of the _____________.
external oblique aponeurosis
Give the boundaries of the inguinal canal – Anterior wall, posterior wall, roof (lateral, central, and medial), and floor (lateral, central, and medial).
• Anterior wall: External oblique aponeurosis; its lateral part is reinforced by internal oblique.
• Posterior wall: Transversalis fascia; reinforced by the inguinal falx (conjoint tendon).
• Roof: Formed laterally by the transversalis fascia, centrally by the internal obliques and transversus abdominis, and medially by the medial crus of the externl oblique aponeurosis.
• Floor: Formed laterally by the iliopubic tract, centrally by the gutter formed from the infolded inguinal ligament, and medially by the lacunar ligament.
What structures lie anterior (3) and posterior (4) to the first part of the duodenum?
Anterior: Peritoneum, gallbladder, and quadrate lobe.
Posterior: Portal vein, bile duct, gastroduodenal artery and IVC.
What are the three layers of covering for the spermatic cord?
The coverings of the spermatic cord include the following:
• Internal spermatic fascia: derived from the transversalis fascia.
• Cremasteric fascia: derived from the investing fascia of both the superficial and deep surfaces of the internal oblique muscle.
• External spermatic fascia: derived from the external oblique aponeurosis and its investing fascia.
What is the innervation for the cremaster muscle?
The cremaster muscle is innervated by the genital branch of the genitofemoral nerve (L1, L2), a derivative of the lumbar plexus.
What are the four tissue layers of the spermatic cord and where are they from?
1.) External spermatic fascia – Extension of the external oblique aponeurosis.
2.) Cremasteric muscle and fascia – Continuation of the internal oblique muscle and fascia.
3.) Internal spermatic fascia – Continuation of the transversalis fascia.
What is the nerve supply of the scrotum? –Anterior 1/3 (2), Posterior 2/3 (2).
1.) Anterior 1/3 by ilioinguinal, genital branch of genitofemoral (L1).
2.) Posterior 2/3 by posterior scrotal branch of pudendal nerve(S3) and posterior cutaneous nerve of thigh.
• Branches of lumbar plexus to the anterolateral surface.
• Branches of sacral plexus to posterior and inferior surfaces.
What is the blood supply of the scrotum (4)?
Supplied by superficial and deep external pudendal artery, scrotal branch of internal pudendal artery and cremasteric branch of inferior epigastric artery
List the five characteristics of an INDIRECT inguinal hernia.
1.) Occurs through deep inguinal ring
2.) Descends into scrotum
3.) Lies lateral to inferior epigastric vessels
4.) Congenital and is associated with process vaginalis
5.) Younger age
List the five characteristics of a DIRECT inguinal hernia.
1.) Occurs through posterior wall of inguinal canal
2.) Not descends into scrotum
3.) Lies medial to inferior epigastric vessels
4.) Acquired and is associated with weakness of posterior wall of inguinal canal
5.) Older age
Give the medial, lateral, and inferior borders of Hesselbach's Triangle.
Inferior epigastric artery
*Direct inguinal hernia occur through this*
At which vertebral and visceral landmark does the esophagus end?
Ends at cardiac orifice of stomach, opposite T11.
1.) What is the arterial supply for the abdominal part of the esophagus (2)?
1.) The arterial supply of the abdominal part of the esophagus is from the left gastric artery, a branch of the celiac trunk, and the left inferior phrenic artery.
2.) Inferior thyroid branch of the thyrocervical trunk.
p.230 Moore, #63
What supplies innervation to the esophagus?
Dervied from VAGI nerves (esophageal plexus, formed by the VAGAL trunks) and thoracic sympathetic trunks.
The pyloric orifice is approximately _____ cm to the _____ of the midline.
approximately 1.25 cm to the right of the midline.
1.) Anteriorly, the stomach is related to what three structures?
2.) Posteriorly, the stomach is related to which two structures?
3.) The posterior surface of the stomach forms most of the anterior wall of the _______.
1.) the diaphragm, left lobe of liver, and anterior abdominal wall.
2.) the omental bursa and pancreas
3.) omental bursa
The transverse colon is related ______ and ______ to the stomach as it courses along the ________ of the stomach to the ________.
-inferiorly and laterally
- as it courses along the greater curvature
-to the left colic flexure.
p.232, see iPad Rohen bookmark
What structures form the bed of the stomach (6)?
*The structures that form the posterior wall of the omental bursa*
-the left dome of the diaphragm, spleen, left kidney and suprarenal gland, splenic artery, pancreas, and transverse mesocolon.
1.) What supplies sympathetic supply to the stomach?
1.) T6-T9 via great splanchnic nerve to celiac plexus.
2.) Anterior and posterior vagal trunks.
IMA arises in front of which vertebral level(s)?
What supplies SNS innervation to the large intestine?
The liver is covered by peritoneum except at the _________ and _________.
hepatic portal and the bed of the gall bladder.
What are the five relations to the liver?
1.) R side of anterior stomach
2.) 1st part of duod.
3.) Gall bladder
4.) R colic flexure and transv. colon
5.) R kidney and suprarenal glands
The hepatic fissures are formed by what four structures?
1.) Round ligament
2.) Fissure of ligamentum venosum
3.) Fossa for the gall bladder
4.) Fissure for IVC.
Describe the hepatorenal space, aka ? – A _______ extension of the _______ space, lying between the ____ part of the visceral surface of the liver and the ______ and ________.
aka Morison pouch: A posterosuperior extension of the subhepatic space, lying between the right part of the visceral surface of the liver and the right kidney and suprarenal gland.
What separates the liver into left and right lobes?
The falciform ligament and the left sagittal fissure separates a large right lobe from a much smaller left lobe.
What enters and leaves the porta hepatis?
Hepatic portal vein, hepatic artery, and lymphatic vessels, the hepatic nerve plexus, and hepatic ducts (L and R converge to form the common hepatic duct).
The functional "left" liver includes which anatomic lobes?
LEFT LOBE, CAUDATE and QUADRATE LOBES.
1.) The hepatic portal vein, a short, wide vein, is formed by the ________ and ________ veins posterior to the ___________.
2.) It ascends anterior to the ________ as part of the __________ in the _________.
1.) superior mesenteric and splenic veins posterior to the neck of the pancreas.
2.) anterior to the IVC as part of the portal triad in the hepatoduodenal ligament.
Blood from the SMV, rich in absorbed nutrients from the intestines, passes mostly to the _____ liver.
What anatomical feature makes the porto-systemic anastomoses possible?
Hepatic portal vein and its tributaries have no valves.
1.) Where does the gall bladder lie on the liver?
2.) What are the relations of the body, neck, and cystic duct of the gallbladder to the superior part of the duodenum?
1.) At the junction between the right and left lobes.
2.) the body of the gallbladder lies anterior to the superior part of the duodenum, and its neck and cystic duct are immediately superior to the duodenum
At which CC is the fundus of the gallbladder located?
tip of 9th CC in the MCL.
What forms the common bile duct?
Cystic duct connects to common hepatic duct to form the common bile duct.
1.) What are the three contents of Calots triangle (laterally, medially, superiorly)?
2.) What are the boundaries of the cystohepatic triangle (lateral, medial, superior)?
1.) Cystic duct laterally, common hepatic medially, cystic artery superiorly.
2.) Cystic duct laterally, common hepatic medially, inferior border of the liver superiorly.
On which 3-4 structures does the head of the pancreas rest on posteriorly?
Rests posteriorly on the IVC, right renal artery and vein, and left renal vein.
What is the relationship of the bile duct to the head of the pancreas?
The bile duct lies in a groove on the posterosuperior surface of the head or is embedded in its substance.
What is the relationship of the hepatic portal vein to the neck of the pancreas?
The SMV joins the splenic vein posterior to the neck to form the hepatic portal vein.
1.) Which two structures does the body of the pancreas cross?
2.) It lies in the floor of what, helping to form what structure?
1.) Crosses over the aorta and L2 vertebra.
2.) Lies in the floor of the omental bursa (helping form part of the stomach bed).
The posterior surface of the body of the pancreas is in contact with which 5 structures?
Is in contact with the aorta, SMA, left suprarenal gland, left kidney, and renal vessels.
The tail of the pancreas lies anterior to the ________, where it is closely related to the ________ and the _________.
-lies anterior to the left kidney.
-splenic hilum and the left colic flexure.
Give the relationships of the spleen (anteriorly, posteriorly, inferiorly, medially)
The relations of the spleen are:
• Anteriorly, the stomach.
• Posteriorly, the left part of the diaphragm, which separates it from the pleura, lung, and ribs 9–11.
• Inferiorly, the left colic (splenic) flexure.
• Medially, the left kidney.
List the three ligaments of the spleen and where they attach on both the spleen and other organs.
*First two attach at hilum*
Gastrosplenic ligament: To greater curvature of the stomach.
Splenorenal ligament: To left kidney.
Phrenocolic ligament: Spleen sits on the phrenocolic ligament.
The splenic hilum is often in contact with the _____________ and constitutes the left boundary of the _________.
-tail of the pancreas
Describe the domes of the diaphragm – i.e. which is higher, and which levels do each rise to during expiration?
Two domes: Right higher than left – Ascends to 5th rib on RIGHT, and 5th ICS on LEFT during expiration.
Give the origins of the diaphragm (sternal, costal, lumbar, crura)
Sternal: Inner surface of xiphoid process.
Costal: CC and lower six ribs.
Lumbar: Medial and lateral arcuate ligaments.
Crura: Musculotendinous bundles from bodies of L1-L3; right and left.
At which vertebral levels/landmarks does the abdominal aorta begin and end?
Begins anterior to T12 body and ends (bifurcates) at L4.
At which vertebral levels do the following structures arise:
1.) Celiac trunk
4.) Gonadal (testicular or ovarian) arteries
At which vertebral levels do the following veins arise:
1.) Hepatic veins
2.) Inferior phrenic vein
3.) Suprarenal vein
4.) Renal veins
5.) Gonadal veins
6.) Lumbar veins
7.) Common iliac veins