What is the abdomen in relation to the trunk?
The part between thorax and pelvis
True/False: The abdomen is a flexible, dynamic container housing most of the organs of the alimentary system and part of the urogenital system.
True
Through what type of contraction is the muscular roof, anterolateral wallsm and floor that raises internal pressure to aid air expulsion or substances?
Voluntary, reflexive contraction
What covers the anterolateral wall and organs against the posterior wall?
Periotneum
What is formed between the viscera and the abdominpelvic cavity?
Peritoneal cavity
What structure “separates” the abdominal and pelvic cavities?
Pelvic inlet
What is the name of the two sagittal planes?
Midclavicular to midinguinal
What does the transverse plane cross through?
The coastal cartilages of 10th row (also called subcostal plane)
What is the plane that passes through the iliac tubercles and L5?
Transtubercular
What plane passes through the ASIS on each side?
Interspinous
What plane passes halfway between the manibrium and pubic symphysis?
Transpyloric
What are the nine region used to describe the location of organs, pains, and pathologies?
Right Hypochondriac, Right Flank , Right Inguinal, Epigastric, Umbilical, Hypogastric, Left Hypochondriac, Left Flank, Left Inguinal
What planes intersect to create the Right Hypogastric region?
R MCL x transtubercular
What planes intersect to create the epigastric region?
Transtubercular and MCLs
What planes intersect to create the Left Hypochondriac region?
L MCL x transtubercular
What planes intersect to create the Left flank region?
R MCL x interspinous x subcostal
What planes intersect to create the umbilical region?
MCLs x subcostal x Interspinous
What planes intersect to create the left flank region?
L MCL x subcostal x interspinous
What planes intersect to create the right inguinal region?
L MCL x interspinous
What planes intersect to create the hypogastric region?
MCLs x interspinous
What planes intersect to create the Left Inguinal region?
Interspinous x L MCL
What are the four quadrants that are created by the median plane and transumbilical plain?
RUQ, LUQ, RLQ, LLQ
What are the organs of the RUQ?
R lobe liver, Gallbladder, Pylorus of stomach, Duodenum, Head of pancreas, R suprarenal gland, R kidney, R colic flexure, ascending colon sup, 1/2 Transverse colon
What are the organs of the LUQ?
L lobe liver, Spleen, stomach, jejunum, proximal ileum, body and tail of pancreas, L kidney, L suprarenal gland, L colic flexure, Half transverse colon, Descending colon sup
What are the organs of the RLQ?
Cecum, appendix, ileum, ascending colon inf, R ovary, R uterine tube, R ureter, R spermatic cord
What are the organs of the LLQ?
Sigmoid colon, Descending colon inf, L ovary, L uterine tube, L spermatic cord
To what structures does the anterolateral abdominal wall extend to?
Thoracic cage -> pelvis
What are the components of the anterolateral abdominal wall?
Skin, SubQ tissue: Camper -> scarpa, deep fascia, muscles, extraperitoneal fat, parietal peritoneum
What are the muscles of the anterolateral wall?
External oblique, internal oblique, Rectus Abdominus, Transverse Abdominus, Pyramidalis
What structure forms between the aponeuroses of the anterolateral abdominal muscles?
Rectus sheath
What structure runs down the midline of the abdomen wall?
Linea alba
Between what two structure does the linea alba run between?
Xiphoid process and pubic symphysis
What is the arcuate line?
demarcates the transition between the aponeurotic posterior wall of the sheath covering the superior three quarters of the rectus and trasversalis fascia covering the inferior quarter
What structures are also found in the rectus sheath?
Superior and inferior epigastric arteries and veins, lymphatic vessels, and distal portions of thoraco-abdominal nerves
All the layers of the rectus sheath fuse to what structure?
Umbilicus
What is the OINA of the external oblique?
O: ribs 5-12
I: Linea alba, pubic tubercle, anterior 1/2 of iliac crest
N: Thoraco-abdominal nerve (T7-11) and subcostal nerve (T12)
A: Compress and support viscera, Flexion of trunk, Rotation of trunk
Where do the fibers of the EO become aponeurotic?
MCL and spino-umbilical line
What is the OINA of the internal oblique?
O: thoracolumbar fascia, ant 2/3s of iliac crest, connective tissue of lateral 1.3 of inguinal ligament
I: Inf borders of 10-12 ribs, linea alba, pecten pubis
N: T6-12 and L1 ant rami
A: compress and rotate viscera, Flexion of trunk, Rotation of trunk
What is the OINA of the tranverse abdominus?
O: Internal surfaces of 7-12 costal cartilages, thoracolumbar fascia, iliac crest, connective tissue deep to lateral 1/3 of inguinal ligament
I: linea alba, pubic crest, pecten pubis
N: T6-12 and L1 anterior rami
A: compress and support the viscera
What is the OINA of the rectus abdominus?
O: pubis symphysis, pubic crest
I: Xiphoid process and 5-7 costal cartilages
N: T6-12 anterior rami
A: flexes trunk, Compresses viscera, Stabilizes and controls tilt of pelvis (antilordosis)
What are the paired rectus muscles separates by?
Linea abla
What structure exists within the rectus abdominus?
Tendinous intersections
What is the pyramidalis muscle?
abest in 20% of people, small, insignificant triangular muscle. Lies anterior to the inferior part of RA and attaches to anterior surface of pubis and anterior pubic ligament
What supplies the majority of the abdominal wall?
Anterior rami of T7-T12
What are they and what structures do the thoraco-abdominal nerves supply?
anterior rami of T7-11, supply the abdominal skin @ and IO, TA muscles
What are they and what structures do the lateral cutaneous branches of nerves supply?
T7-9 or t10, supply skin supply the skin of the L and R hypochondriac regions
What are they and what structures do the anterior cutaneous branches of nerves supply?
T7-9, supply the skin abobe umbilicus, T10, supplies the skin around umbilicus, T11+T12+ iliohypogastric + Ilioinguinal, supply the skin below umbilicus
What is the subcostal nerve and what does it supply?
Anterior ramus of T12, supplies muscles of the anterolateral abdominal wall and overlying skin superior to iliac crest but inf to umbilicus
What is the Iliohypogastric nerve and what does it supply?
Anterior ramus of L1, supplies skin over iliac crest, upper inguinal, hypogastric regions, IO and TA muscles
What is the ilioinguinal nerver and what does it supply?
Anterior ramus of L1, supplies skin of lower inguinal region, mons pubis, anterior scrotum/labium, medial thigh, inferiormost IO and TA
What is the origin, course, and distribution of the musculophrenic artery?
O: Internal thoracic artery
C: descends along costal margin
D: hypochondriac region, anterolateral diaphragm
What is the origin, course, and distribution of the superior epigastric artery?
O: Internal Thoracic artery
C: Descends in rectus sheath deep to RA
D: RA, epigastric and upper umbilical regions
What is the origin, course, and distribution of the intercostal arteries?
O: Aorta
C: beyond ribs to descend abd. wall between IO and TA
D: Lumbar/Flank region
What is the origin, course, and distribution of the subcostal artery?
O: Aorta
C: beyond ribs to descend abd. wall between IO and TA
D: Lumbar/Flank region
What is the origin, course, and distribution of the inferior epigastric artery?
O: External Iliac artery
I: runs superiorly and enters rectus sheath, runs deep to RA
D: RA, pubic and umbilical regions
What is the origin, course, and distribution of the deep circumflex iliac artery?
O: Exteral Iliac artery
C: runs Deep aspect of abd. wall, parallel to inguinal ligament
D: Iliacus, inguinal region, iliac fossa
What is the origin, course, and distribution of the Superficial circumflex artery?
O: Femoral Artery
C: Runs in subQ tissue along inguinal ligament
D: Superifcial wall of inguinal regions and adj. anterior thigh
What is the origin, course, and distribution of the superificial epigastric artery?
O: femoral artery
C: Runs in subQ tissue toward umbilicus
D: Superficial wall of pubic and inferior umbilic region
What is a surgical method for removing unwanted subcutaneous fat using a suction tube and high vacuum pressure?
Liposuction
Which fascia provides a plane that can be opened, enabling a surgeon to approach structures without entering the peritoneal sac?
Endoabdominal fascia
Describe an abdominal protrusion.
Anything that causes the abdomen to protrude, can be food, feces, fetus, flatus, fat, fluid, ascites (serous fluid), Large mass (tumor, enlarged organ)
What is an umbilical hernia?
A hernia in umbilical ring due to failure to normally close, common in neonates
What is an epigastric hernia?
A hernia through the linea alba. typicall just lobules of fat
What is a Spligelian hernia?
Occur along semilunar line.
Describe a longtiduinal incision.
Midline/ paramedian incisions, good for exploratory operations due to best exposure to viscera, can extend as necessary with minimal complications
Describe a median incision.
Any part of the linea alba, won’t cut any major muscles, BVs, or nerves.
Describe an oblique incision.
(McBurney) 2.5 cm superomedial to the ASIS on the spino-umbilical line
Describe a suprapubic incision.
Horizontal with a slight convexity along pubic hairline (c-section)
Describe a subcostal incision.
parallel but at least 2.5 cm inf to costal margins to avoid the 7th and 8th spinal nerves, access to gallbladder and biliary ducts on R side and spleen on the :
What is a pararectus incision?
Along the lateral border of the rectus sheath
Why is the pararectus incision so high risk?
Risk to cutting nerve supply to RA
Describe an endoscopic procedure.
Minimally invasive, tony perforations, allow entry of instruments (laparoscope)
What makes up the internal surface of the anterolateral abdominal wall?
Transversalis fascia, extraperitoneal fat, parietal peritoneum
What “structure(s)” are exhibited in the infra-umbilical part of the internal surface?
Umbilical folds
How many umbilical fold are there?
- Two median, two lateral, one medial
What are the depressions lateral to the umbilical folds?
Peritoneal fosse
What supra-umbilical structure extends between the superior anterior abdominal wall and liver?
Falciform ligament
What is another term for the inguinal region?
Groin
The inguinal region is a passage from what cavity?
Abdominal
What is the dense band constituting the inferiormost part of the EO aponeurosis?
Inquinal ligament
What structure forms the medial boundary of the subinguinal space, between the superior pubic ramus to tubercle?
Lacunar ligament
What structure runs along the pectin pubis?
Pectineal ligament
What structure is formed by the bypassing of the pubic tubercle and crossing the linea alba to blend with the lower fibers of the EO aponeurosis?
Reflected inguinal ligament
What structure is the thickened inferior margin of the transversalis fascia, appearing as a fibrous band running parallel to posterior to inguinal ligament?
Iliopubic tract
What is the weak area in the inguinal region that is the site of direct and indirect hernias?
Myopectineal orifice
Describe the difference between direct and indirect hernias.
Direct hernias form in the abdominal canal, indirect ones do not
What is formed in relation to the relication of the testis during fetal development?
Inguinal canal
What is the main occupant of the inguinal canal?
Spermatic cord/round ligament of uterus
What muscle aponeourosis forms the inguinal canal?
EO
What are the superficial inguinal rings?
exit by the spermatic cord/round ligament
What are the deep inguinal rings?
Entrance to inguinal canal
What other structures does the inguinal canal contain?
Inguinal nerve, blood and lymphatic vessels
What is a hydrocele in the inguinal region?
Excess fluid in a persistent processus vaginialis, testis, spermatic cord - detection by transillumination
What is a hermatocele of the testis?
Collection of blood in the tunica vaginalis that results from trauma
What is a spermatocele?
Retention cyst in the epidymis
What is an epidymal cyst?
Collection of fluid anywhere in the epidymis
What is a variocele?
varicose vein plexus
What is a thoraco-epigastric vein?
Formed between superior epigastric vein and lateral thoracic vein
What are the two layers of the peritoneum?
Parietal and visceral
What does the parietal peritoneal line?
Abdominal wall
What does the visceral peritoneal line?
Visceral organs
True/False: The peritoneum has separate neurovasculature than the wall lining it.
False, same
What is created in the potential space between the peritoneal layers?
Peritoneal cavity
What surrounds the peritoneal cavity?
peritoneal fluid
What is the double layer of peritoneum that encloses the abdominal organs?
Mesentery
What does the mesentery function to connect?
Organs and body wall
What is the double layer extension/fold of peritoneum that passes from stomach and proximal duodenum to organs in the abdominal cavity?
Omentum
What is the greater omentum?
Prominent, four layered peritoneal fold that connects the stomach to transverse colon
What is the lesser omentum?
Much smaller, double layered peritoneal fold that connect the lesser curvature of the stomach and proximal part of duodenum to the liver
What is the double layer of peritoneum that connect an organs with another to the abdominal wall?
Peritoneal ligament
What connects the liver to the anterior abdominal wall?
Falciform ligament
What connects the liver to the stomach?
Hepatogastric ligament
What connects the liver to the duodenum?
Hepatoduodental ligament
What connects the stomach to the inferior surface of the diaphragm?
Gastrophrenic ligament
What connects the stomach to the spleen?
Gastrosplenic ligament
What connects the stomach to the transverse colon?
Gastrocolic ligament
What is the inflammation of peritoneum?
Peritonitis
Describe peritoneal adhesions.
damage or infection fill with fibrin which changes to fibrous tissue
What is the surgical separation of peritoneal separations?
Adhesiolysis
What is the surgical puncture of the peritoneal cavity for the aspiration or drainage of fluid?
Paracentesis
What is the removal of soluble substances and excess water by the transfer across the peritoneum?
peritoneal dialysis
What is a circumscribed collection of pus in the subphrenic recess?
Abscess
How does an abscess form?
From a perforation of a duodenal ulcer, rupture of gallbladder, or perforation of appendix
What results from an inflamed/injured pancreas in the passage of pancreatic fluid into the bursa?
Pancreatic pseudocyst
What is the removal of the gallbladder?
Cholecystectomy
What is the sac-like cavity that lies posterior to the stomach, lesser omentum, and adj. structures?
Omental bursa
What is the communication point for the omental bursa with the greater sac?
Omental foramen
What is the muscular tube that extends from the pharynx to stomach?
Esophagus
Approximately, how long and how wide is the esophagus?
25 cm, 2 cm
What is the function of the esophagus?
Transport of food through peristaltic action from the oral cavity to stomach
Where are the three constrictions to aid in food propellant?
Cervical (upper esophageal sphincter), thoracic (broncho-aortic), diaphragmatic constriction
What does the esophagus follow the curvature of?
Vertebral column
What structure does the esophagus pass through in the right crus of the diaphragm?
Esophageal hiatus
What structure does the esophagus terminate at by entering the stomach at?
Cardial orifice
What two layers of muscles makes up the esophagus?
Circular and external longitudinal
Describe the makeup of muscle in the esophagus.
Exterior: striated voluntary. Inferior 1/3: smooth muscle. Middle 1/3: combo
What is the expandable part of the digestive tract between the esophagus and small intestine?
Stomach
What is the function of the stomach?
Accumulate ingeted food, enzymatic digestion, and transport into duodenum
Gastric juice converts food to what for easier passage through the intestine?
Chyme
how many liters is the stomach capable of holding?
2-3 L
What are the four parts of the stomach?
Cardia, fundus, body, pylorus
What is the part of the stomach that surrounds the opening of the esophagus?
Cardia
What is the part of the stomach that dilates related to the dome of the diaphragm?
Fundus
What structure separates the cardiac and fundus?
Cardial notch
What is the body of the stomach?
The center, between the fundus and pylorus
What is the funnel-shaped outflow region of the stomach?
Pylorus
Describe the pathway through the pylorus.
Pyloric antrium -> pyloric canal -> pylorus -> pyloric orifice
What is the specific piece of the pyloric part of the stomach that is the sphinctric region controlling the discharge of stomach contents?
Pylorus
Through which structure does chyme flow through in the stomach to enter the duodenum?
Orifice
What is the primary site for absorption of nutrients from ingested materials?
Small intestine
What are the three parts of the small intestine?
Duodenum, jejunum, ileum
Rank the size order of the three parts of the small intestine.
ileum > jejunum > duodenum
What is the first portion of the small intestine?
Duodenum
What is the middle portion of the small intestine?
Jejunum
What is the bottom portion of the small intestine?
Ileum
Which portion of the small intestine is c shaped and has biliary and pancreatic ducts that enter into it?
Duodenum
Which portion of the small intestine begins at duodenal flexure, where the GI resumes?
Jejunum
Which portion of the small intestine ends and meets the cecum?
Ileum
What is the approximate length of the jejunum and ileum together?
6-7 m
What attaches the small intestine to the body wall?
Mesentery
Between jejunum and ileum: which has a deeper red vs paler pink?
Jejunum
What is the approximate length of jejunum vs ileum?
2-4cm, 2-3 cm
Between jejunum and ileum: which has greater vascularity?
jejunum
Between jejunum and ileum: which has a longer vasa recta?
Jejunum
Between jejunum and ileum: which has large, tall folds vs low sparse, absent folds?
Jejunum
Between jejunum and ileum: which has many lymph nodes over the other?
Ileum
Between jejunum and ileum: which has few, large arcade loops vs many short arcade loops?
Jejunum
What is the first 2 cm of duodenum?
Ampulla
What structure is the entrance between the duodenum and the ducts leading to it?
Papilla
What is the water absorption site from the ingestible residues of liquid chyme, coverting them to solid waste?
Large intestine
What are the parts of the large intestine?
cecum, appendix, colon, rectum and anal canal
What are the distinguishable parts of the large intestine?
omental appendices (small, fatty projections), teniae coli (3 bands: mesocolic tenia, omental tenia, free tenia), haustra (sacculations of the wall of the colon between the teniae)
What structure connects the ileum and cecum?
Ileocecal valve
What is the blind intestinal pouch that lies in the iliac fossa of RLQ?
cecum
What is the blind intestinal diverticulum containing masses of lymphoid tissue?
Appendix
What part of the large intestine encircles the small intestine and functions to move fluid from fecal matter?
Colon
What are the four parts of the colon?
Ascending colon (passes from R side of abd @ cecum ro R lobe of liver, turning at the R colic flexure ~ 9-10 ribs) -> Transverse colon (R colic flexure to L colic flexure) -> descending colon (L colic flexure and L iliac fossa) -> Sigmoid colon (S-shaped loop linking descending colon to rectum)
What is the fixed terminal part of the small intestine, continuous with the sigmoid colon ~ S3?
Rectum
What continues after the rectum to the outside?
Anal canal
What condition results from increased BP causing esphogeal varices?
Portal hypertension
What condition can increase the likelihood of portal hypertension?
Cirrhosis
What is pyrosis?
Heartburn - burning sensation usually resulting from regurgitation of food/gastric fluid (GERD)
Is pyrosis common?
Yes
What can pancreatic pseudocysts and abscesses in the omental bursa do to the stomach?
Push it anteriorly
What is a hiatal hernia?
A protrusion pf part of the stomach into the mediastinum through the esophageal hiatus
Describe the difference between a para-esophageal hiatal hernia and sliding hiatal hernia?
Para-esophageal: cardia remains in position but fundus extends, sliding: esophagus, cardia, and fundus extend through eso. hiatus
What is the results of the failure of smooth muscle fibers encircling the pyloric canal to relax nomrally?
Pylorspasm
What is the marked thickening of smooth muscle of the pylorus?
Congenital hypertrophic pyloric stenosis
What is the surgical treatment of congential hypertrophic pyloric stenosis?
Pyloromyotomy
What is the removal of the stomach?
Gastrectomy
What results from an infection of H. pylori?
Gastric ulcers
True/False: An anterior gastric ulcer may erode the stomach wall into the pancreas, resulting in back pain.
False, posterior gastric ulcer may do this
How can you distinguish between organic pain and visceral pain?
organic - poorly localized, visceral - epigastric region
What type of ulcers can cause peritonitis?
Dudoneal ulcers
How does ischemia of intestine occur?
By emboli, thrombus, or plague (atherosclerotic occulsion) - can result in necrosis
What is the acute inflammation of the appendix?
Appendicitis
What is the surgical removal of the appendix?
Appendectomy, through McBurney’s incision
What is the condition resulting in chronic inflammation/ulceration of the colon/rectum?
Colitis (Chrohn’s)
What is the removal of the colon?
Colectomy
What is the surgical operation in which part of the ileum is diverted to an artificial opening to allow egress of contents?
Ileostomy
What surgical procedure creates an artificial cutaneous opening in the colon for egress of contents?
Colostomy
What procedure utilizes a long, flexible, fiberoptic endocscope to enter the colon through the anus and rectum for view of colon?
Colonoscopy
Where do most intestinal tumors occur?
Sigmoid colon, rectum, or ascending colon
What is the disorder in the which multiple external invaginations develop alone the intestine?
Diverticulosis
What is the condition in which diverticulum rupture?
Diverticulitis
Volvulus of the sigmoid colon can lead to what?
Ischemia and obstipation -> necrosis
What is the ovoid, purplish, pulpy lymphatic organ?
Spleen
What is the approximate size of the spleen?
Shape of fist
What are the functions of the spleen?
Defense system as a site of lymphocyte proliferation/elimination of old, damaged RBCs and immune surveillance
True/False: You cannot live without your spleen.
False, you can, it is not vital to sustain life
Where does the spleen rest?
L colic flexure ~ 9-11th ribs
What is the elongated, accessory digestive gland?
Pancreas
What is the approximate location of the pancreas?
~ L1, L2, posterior to stomach between spleen and duodenum
What are the functions of the pancreas?
Produce exocrine secretion (pancreatic juice), supply body with insulin and glucagons from the Islets of Langerhans
How does pancreatic juice flow to the duodenum?
Main and accessory pancreatic ducts
What are the components of the pancreas?
Head, neck, body, and tail
What is the largest gland, and, second to skin, organ?
Liver
True/False: All nutrients absorbed are initially conveyed to the liver by the portal venous system.
True
What are the functions of the liver?
Metabolic activities, stores glycogen, secrete bile, processes the products of digestion and exo/endogenous substances (drugs, toxins) that enter circulation
Describe the passage of bile from the liver.
via bile duct to join w/ cystic ducts to form the common hepatic duct -> hepatic artery
What is the storage site of bile?
Gallbladder
What is the approximate size of the gallbladder?
7-10 cm
What causes release of bile from the gallbladder?
fat enters the duodenum via cystic duct to bile duct
True/False: The spleen, pancreas, liver can be ruptured.
True
What is the removal of the spleen?
Splenectomy
What is the removal of the pancreas?
Pancreatectomy
What is a lobectomy?
Removal of part of the liver
what is the removal of the gallbladder?
Cholecystectomy
What is cholelithiasis?
Gallstones - crystallized concretion in GB, cystic duct, or bile duct
What is inflammaton of the pancreas?
pancreatitis
What does a whipple procedure do?
Removal of pancreatic cancer
What is a subphrenic abscess and how is it “treated”?
Collection of pus, drained by incision
What is the enlargement of the liver due to increased blood?
Hepatomegaly
What is the destruction of hepatocytes becoming replaced with fat and fibrous tissue?
Cirrhosis
What is the surgical procedure in which portal hypertension is reduced by connecting the hepatic portal vein and IVC?
Portosystemic shunt
What is the function of the kidneys?
remove excess water, salts, and wastes of protein metabolism converting it to urine
Where is the location of the kidneys?
Approx. T12-L3 along posterior wall
What are the muscular ducts that carry urine from the kidney to the bladder?
Ureters
What do the ureters “run” over?
Common iliac arteries
What are the yellowush hormone and steroid producing glands?
Supradrenal
Where are the supradrenal glands located?
Above the kidney, below the diaphragm
What is the hollow pouch with strong, distensible muscular walls that serves as a temporary reservoir for urine?
Bladder
What is the muscular tube that converys urine from the bladder?
Urethra
True/False: the urethra is longer in females.
False, it is longer in males
What is the female reproductive organ that produces ova/oocytes and estrogen?
Ovaries
What is the female reproductive organ that transports ovum from ovary to uterus?
Fallopian (uterine) tube (one pair)
What is the female reproductive hollow organ that is thick walled prividing the environment for embryonic/fetal development?
Uterus
What is the female reproductive organ that serves as the passageway from uterus?
vagina
What is the extension of the vagina that dilates to allow for fetal passage?
Cervix
What is the male reproductive organ that is one of two reproductive glands too produce spermatozoa and testosterone?
Testis
What is the male reproductive organ that lies between the bladder and rectum that secretes a thick, alkaline fluid that mixes with sperm?
Seminal vesicle
What is the male reproductive organ that begins in the epididmysis and eventually joins with duct of seminal vesicle?
Vas deferens
What is the male reproductive organ that is a slender tube that arises by the union of the Seminal vesicle and the vas deferens?
Ejaculatory duct
What is the male reproductive organ that is an accessory gland that secretes seminal fluid?
Prostate
What is a collection of pus around the kidney?
perinephric abscess
What is the term given to a dropped kidnye?
Nephroptosis
What is a congenitally misplaced kindey?
Ectopic kidney
What is the preferred treatment of renal failure,, removing the defective kidney and replacing it with another without damaging surrounding/supporting structures?
Renal transplant
What is a renal cyst?
A cyst in the kidney - can be polycystic disease
What is renal vein entrapment syndrome?
Compression of Left renal vein
What are the signs/symptoms of renal vein entrapment syndrome?
Hematuria, proteinuria, flank pain, nausea, vomiting, L testicular pain (in males)
What is the term given to an additional kidney developed by the separation of blastomas?
Supernumerary kidney
What is a retrocaval ureter?
a rare congenital anomaly with the ureter passing posterior through the IVC
What is the term given to a fused, U-shaped kidney?
horseshoe kidney
How does a horseshoe kidney form?
Mesentaric artery fails to normally relocate the kidneys
True/False: A horseshoe kidney can cause an array of symptoms.
False, generally produce no symptoms or problems
What is the official term of a kidney, ureter stone?
Renal, ureteric calculus
What is the double-domed, musculotendinous partition that separates the thorax and abdomen?
Diaphragm
True/False: The diaphragm is the major muscle for respiration.
True
What are the compositions of the diaphragm?
Central tendon, sternal portion, costal portion, lumbar portion
What is the central tendon?
Boomerang shape insertion point for peripheral muscular portions of the diaphragm.
What is the sternal portion of the diaphragm?
Two muscular slips that arise from the xiphoid process and insert to central tendon
What is the costal portion of the diaphragm?
Wide muscular slips arise from the interior surfaces of lower 6 ribs and costal cartilage to CT
What is the lumbar portion of the diaphragm?
Arises from the medial and lateral ligaments ~ LV1-3 to CT
What does the lumbar portion form?
R and L muscular crura that ascend to CT
What is a crura?
musculotendinous band that arises from the anterior surfaces of the bodies of L1-3, ALL, and IV discs.
Is the right or left crus larger?
R
What LV does the R crus arise from?
L1-3 maybe 4
What LV does the L crus arise from?
L1-2 or 3
What are the four openings in the diaphragm that permit passage of structures between the thorax and abdomen?
IVC foramen (caval opening), Esophagea hiatus, Aortic hiatus, Stenocostal hiatus (triangle, foramen)
What is the caval opening?
The passage between the IVS and R phrenic nerve
Where is the caval opening located?
to R of median plane @ central tendon junction ~ IV disc between T8&9
What is the esophageal hiatus?
The passage between the esophagus and vagal trunks
Where is the esophageal hiatus located?
located superior to and left of the aortic hiatus ~ T10
What is the aortic hiatus?
Passage of aorta and thoracic ducts
Where is the aortic hiatus located?
passes between crura to MAL
What is the sternocostal hiatus?
between sternal and costal attachments of the diaphragm, transmit lymphatic, epigastric vessels
What are the five components of the posterior abdominal wall?
Five lumbar vertebrae and IV discs, wall muscles, diaphragm, fascia, lumbar plexus, and fat, nerves, and lymph nodes.
What fascia exists between the parietal peritoneum and muscles?
Endoabdominal fascia
What is the extensive fascial complex that attaches the muscles to the VC?
Thoracolumbar fascia
What are the muscles of the posterior abdominal wall?
Psoas, iliacus, quadaratus lumborum
What is the OINA of the psoas major?
O: Transverse processes of LV bodies and discs of T12-L5
I: Tendon to lesser trochanter of femur
N: anterior rami of L1-3
A: Thigh flexion, Trunk flexion, Trunk Lateral flexion
What is the OINA of the psoas minor?
O: Bodies and IV discs of T12-L1
I: pubic bone
N: anterior ramus of L1
A: Pelvic and trunk flexion
What is the OINA of the iliacus?
O: iliac fossa, ala of sacrum, anterior sacroiliac ligaments
I: Lesser trochanter of psoas major
N: Femoral Nerve
A: Thigh flexion, Hip stabilization
What is the OINA of the quadratus lumborum?
O: Iliac crest, Iliolumbar ligament
I: Rib 12, transverse processes of upper lumbar vertebrae
N: Subcostal and upper lumbar (L1-4) anterior rami
A: Trunk lateral flexion, Trunk Extension, Hip elevation, stabilization of 12th rib during inspiration
Where do the subcostal nerves arise, course, and distribute?
In the thorax, pass posterior to LCLs into abdomen and run inferiolaterally on the anterior surface of QL passing through TA and IO to supply EO and skin
Where do the lumbar spinal nerves arise and course?
Pass from SC through IV foramina inferior to the corresponding vertebrae, where they split into posterior and anterior rami
What does the posterior rami of lumbar spinal nerves supply?
Muscles of back and overlying skin
What does the anterior rami of lumbar spinal nerves supply?
SKin and muscles of the inferiormost trunk and lower limb
Where is the lumbar plexus of nerves formed?
Anterior to the lumbar tranverse processes, within the proximal attachment of psoas major
What is the lumbar plexus of nerves composed of?
Anterior rami of L1-4, Femoral nerve branch, obturator nerve branch
What and where is the femoral nerve?
L2-L4, emerges @ inf psoas major and innervates the iliacus and passes deep to inguinal ligament/IT to anterior thigh, supplying the hip flexors and knee extensors
What and where is the obturator nerve?
L2-L4, emerges @ med psoas major and passes into lesser pelvis, passing through obturator foramen to pubic ramus to medial knww, supplying the adductor muscles
What and where is the Ilioinguinal nerve?
ant rami of L1, emerges from lateral psoas major and passes across QL and IL, supplying the scrotum, labia, mons pubis, medial thigh, Io and TA
What and where is the Iliohypogastric nerve?
ant rami of L1,received fibers from T12, innervates the skin over the lateral gluteal region and IO and TA
What and where is the Genitrofemoral nerve?
L1-2, pierces psoas major and runs inferior on anterior surfacem deep to psoas fascia, divides laterally to the common and external iliac arteries into femoral and genital branches
What and where is the lateral cutaneous femoral nerve of thigh?
L2-3, runs inferiolaterally oniliacus and enters the thing deep to inguinal ligaemt/IT just medial ASIS, supplies the skin on anterolateral surface of thigh
Describe the passage of blood through the posterior abdominal wall.
Descending thoracic aorta enters abdomen and becomes abdomional aorta @ abdominal hiatus ~T12-L4. -> divides into R and L common iliac arteries that diverge and run inferiolaterally to medial psoas major to pelvic brim -> divides into Internal and External Arteries, internal supplies viscera, external follow iliopsoas) External iliac divides into inferior epigastric and deep circumflex arteries that supply the anterolateral abdominal wall
Describe the venous pattern of the posterior abdominal wall.
Common iliac veins unionize to form IVC ~L5, which returns deoxygenated blood from lower extremities, anterolateral abdominal wall and abdominal pelvic viscera, ascends through caval opening in the diaphragm and continues to the heart. Major veins from the IVC to body = Renal veins, common iliac veins, suprarenal veins, lumbar veins
What structures fuse to form the pelvic girdle?
ilium, ischium, pubis
At what structure does the pelvic girdle fuse together?
Acetabulum
What is the name given to the fused hip bones?
Ox coxae