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Abdomen Flashcards

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1
Q

Name layers of the Anterior Abdomen Wall

A 
• Skin
• Superficial fascia
– Camper (fatty)
– Scarpa (fibrous)
• External oblique
• Internal oblique
• Transversus abdominis
• Transversalis fascia
• Extraperitoneal connective tissue
• Parietal peritoneum
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2
Q

What is femoral sheath?

A

Extension of the transversalis fascia deep
to the inguinal ligament into the thigh containing the femoral artery
and vein and the femoral canal (site of femoral hernia)

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3
Q

Which nerves innervate abdominal wall?

A
  • lower 6 Thoracic spinal nerves

- L1 (ilioinguinal and iliohypogastric branches)

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4
Q

Which arteries supply abdominal wall?

A
  • superior epigastric a. (branch of internal thoracic a.)

- inferior epigastric a. and circumflex iliac a. (branches of external iliac a.)

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5
Q

Which veins drainage abdominal wall?

A
  • superficial epigastric v.
  • lateral thoracic v.
  • great saphenous v.
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6
Q

To which lymph nodes does abdominal lymph drainage?

A
  • axillary nodes

- inguinal nodes

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7
Q

Name the contents of inguinal canal

A

Male:

  • testicular artery
  • pampiniform venous plexus
  • ductus (vas) deferens and its artery
  • autonomic nerves
  • lymphatic duct (to aortic nodes)
  • ilioinguinal nerve (L2)

Female:

  • round ligament of uterus
  • ilioinguinal nerve (L2)
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8
Q

Name the walls of inguinal canal

A
  • superior: int. oblique muscle, transversus muscle
  • inferior: inguinal ligament, lacunar ligament
  • anterior: ext. oblique muscle
  • posterior:
    v Lateral (weak): transversalis fascia
    v Medial: conjoint tendon
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9
Q

Name borders of the inguinal (Hesselbach’s) triangle

A

1) inguinal ligament
2) rectus abdominis m.
3) inferior epigastric artery

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10
Q

Name layers of spermatic cord:

A
  • external spermatic fascia (from external oblique fascia)
  • m. cremaster and fascia (from internal oblique fascia)
  • internal spermatic fascia (from transversalis fascia)
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11
Q

What is the purpose of gubernaculum?

A

It leads testicle to scrotum during its descent

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12
Q

Which nerves maintain cremasteric reflex?

A
  • sensory fibers from ilioinguinal n. (L1)

- motor fibers from genitofemoral n.

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13
Q

Where do cancers of male genitals will metastasize?

A

Testicle cancer will metastasize to aortic nodes; penis and scrotum cancers will metastasize to inguinal nodes

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14
Q

What is processus vaginalis?

A

An evagination of the parietal peritoneum and the peritoneal cavity
extends into the inguinal canal

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15
Q

What is tunica vaginalis?

A

A portion of the processus vaginalis remains patent in the scrotum and
surrounds the testis

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16
Q

What is a reason of congenital inguinal

hernia?

A

Failure of processus vaginalis to fuse. It’s always indirect

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17
Q

What is hydrocele?

A

A collection of serous fluid in the
tunica vaginalis. Doesn’t reduce in size when patient is lying. Is a result of incomplete fusion of processesus vaginalis

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18
Q

What is the site of indirect inguinal hernia?

A

Deep inguinal ring

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19
Q

What is the site of direct inguinal hernia?

A

Weak part of posterior inguinal canal wall

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20
Q

How to distinguish direct and indirect inguinal hernias?

A

1) by inferior epigastric a. (it’s medial to indirect hernia and lateral to direct hernia)
2) compressing superficial ring -> cough -> compressing (blocking) deep ring (if there still is a push under superficial ring it means that hernia can’t go to it site (deep ring) and it’s indirect; if there is no push under superficial ring it means that hernia goes to another location (not deep ring) and it’s direct)

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21
Q

When does varicocele occur?

A

When blood collects in the pampiniform venous

plexus. It enlarges when patient is standing and reduces in size when patient is lying

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22
Q

Name structures, blood supply and innervation of the foregut

A

Structures:

1) Esophagus
2) Stomach
3) Liver
4) Gallbladder
5) Pancreas
6) Duodenum (1 and 2 parts)

Blood supply: celiac trunk

Innervation:

1) Parasympathetic: n. vagus
2) Sympathetic: preganglionic - T5-T9, postganglionic - celiac ganglion

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23
Q

Name structures, blood supply and innervation of the midgut

A

Structures:

1) Duodenum (2, 3, 4 parts)
2) Jejunum
3) Ileum
4) Ceacum
5) Appendix
6) Ascending colon
7) Transverse colon (2/3)

Blood supply: Superior mesenteric artery

Innervation:

1) Parasympathetic: n. Vagus
2) Sympathetic: preganglionic - T9-T12, postganglionic - superior mesenteric ganglion

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24
Q

Name structures, blood supply and innervation of the hindgut

A

Structures:

1) Transverse colon (1/3)
2) Descending colon
3) Sigmoid colon
4) Rectum
5) Anal canal

Blood supply: Inferior mesenteric artery

Innervation:

1) Parasympathetic: pelvic nerves
2) Sympathetic: preganglionic - L1 - L2, postganglionic - inferior mesenteric ganglion

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25
Name Major intraperitoneal organs
1) Stomach 2) Liver and gallbladder 3) Pancreas (tail) 4) Duodenum (1st part) 5) Jejunum 6) Ileum 7) Ceacum 8) Appendix 9) Transverse colon 10) Sigmoid colon
26
Name Major secondary retroperitoneal organs
1) Duodenum (2, 3, 4 parts) 2) Pancreas (head, neck and body) 3) Ascending colon 4) Descending colon 5) Rectum (upper part)
27
Name Major primary retroperitoneal organs
1) Kidneys 2) Adrenal glands 3) Ureters 4) Aorta 5) Inferior vena cava 6) Rectum (lower part) 7) Anal canal
28
How does foregut rotation occur?
- along long axis of gut tube | - 90° (ventral (liver) to the right, dorsal (spleen) to the left
29
How does midgut rotation occur?
- along superior mesenteric artery | - 270° counterclockwise
30
Name the borders of the epiploic foramen
* Anteriorly: hepatoduodenal ligament and the hepatic portal vein * Posteriorly: inferior vena cava * Superiorly: caudate lobe of the liver * Inferiorly: first part of the duodenum
31
Name congenital abnormalities of the gut tube
- hypertrophic pyloric stenosis (polyhydramnios) - extrahepatic biliary atresia - annular pancreas (polyhydramnios) - duodenal atresia (polyhydramnios) - omphalocele (midgut loop doesn't return to abdominal cavity => stays in umbilical stalk + multiple anomalies => high mortality) - Ileal (Meckel's) diverticulum (from vitelline duct) - Vitelline fistula (persistence of vitelline duct) - Malrotation of midgut - Colonic agangliosis (Hirschsprung)
32
Name the liver lobes
- Left | - Right ( +caudate, +quadrate)
33
Which lacerated ribs could damage the spleen?
9, 10, 11 on left side
34
How does pancreas receive blood supply?
- Head of pancreas receives blood supply from superior pancreaticoduodenal artery (from common hepatic artery (branch of celiac trunk)) and from inferior pancreaticoduodenal artery (from superior mesenteric artery) - Neck, body and tail of pancreas receive blood supply from splenic artery
35
Name branches of Celiac Trunk
- left gastric artery (supplies lesser curvature of stomach) - splenic artery (gives left gastroepiploic artery to greater curvature of stomach, supplies neck, body and tail of pancreas and spleen) - common hepatic artery (proper hepatic artery and gastroduodenal artery (head of pancreas, duodenum) -> right gastroepiploic artery (supplies greater curvature)
36
Name branches of Superior Mesenteric Artery
1) Inferior pancreaticoduodenal artery (to head of pancreas and duodenum) 2) intestinal arteries 3) ileocolic aretery 4) right colic artery 5) middle colic artery
37
Name branches of Inferior Mesenteric Artery
1) Left colic artery 2) Sigmoid artery 3) Superior rectal artery
38
How does venous drainage from abdominal organs occur?
From intraperitoneal organs and secondary retroperitoneal organs - by portal system From primary retroperitoneal organs - by caval system
39
Name chief portocaval anastomosis
1) Esophageal (azygos and portal) 2) Rectal (Superior (portal) and inferior (caval) rectal veins) 3) Caput Medusae (paraumbilical veins (portal) and superficial abdominal veins (caval)
40
How to distinguish duodenum, jejunum and ileum (histologically)
Duodenum has Brunner's glands (bicarbonates) Ileum has Peyer's patches Jejunum has nothing
41
Name 3 major salivary glands and their function
1) Parotid (serous, opens through Stensen's duct near 2nd upper molar) 2) Submandibular (serous! + mucous, opens through Warton's duct near the base of tongue) 3) Sublingual (mucous, opens by many small ducts)
42
How does autonomic nervous system affect salivary glands?
1) Parasympathetic: make saliva watery by muscarinic receptors (=> anticholinergic -> dry mouth) 2) Sympathetic: make saliva viscous by beta-adrenergic receptors
43
How many zones does hepatic acinus have? Name their functions
Zone 1: closer to triad, most O2, synthesis Zone 2: between 1 and 3 Zone 3: closer to central vein, susceptible to injury, detoxification
44
From which parts does renal system of embryo consist?
- pronephros (involutes) - mesonephros (duct, future ductus defernens in males) - metanephros (future kidney)
45
How does kidney develop?
Ureteric bud (mesonephric bud's diverticulum) penetrates the mesonephric mass). They induct each other to grow
46
Which way does urine pass in embryo?
mesonephric duct -> cloaca -> allantois -> amniotic fluid -> swallowing -> gut absorption -> passing toxins to mommy
47
How does urinary bladder and urethra develop?
Urorectal septum divides hindgut to anorectal canal and urogenital sinus (future urinary bladder and urethra)
48
Which cells produce erythropoietin?
Cortex and medullar fibroblasts
49
From which parts does urinary bladder trigone consist?
2 ureter, 1 urethra (internal urethral sphincter) and trigone muscle in between
50
How does urinary bladder get blood supply?
- from internal iliac artery and umbilical artery | - to internal iliac vein
51
How does urinary bladder innervate?
Parasympathetic: to detrusor m. (in the bladder wall) => stimulation of micturition Sympathetic: to internal urethral sphincter => suppress micturition Pudendal nerve to external urethral sphincter
52
What is spastic bladder?
lesions above sacral spinal cord level -> loss of inhibition of parasympathetic sacral system by CNS -> detrusor muscle is contracted
53
What is atonic bladder?
lesion to sacral spinal cord segments -> loss of parasympathetic innervation -> loss of contraction of detrusor muscle
54
How does ureter pass near the uterus?
It passes under uterine artery ("water under the bridge")
55
From which parts does Pelvic Diaphragm consist?
- m. levator ani | - m. coccyges
56
From which parts does Urogenital Diaphragm consist?
- external urethral sphincter | - transverse perineum muscle
57
Name Perineal Pouches
- superficial PP (between superficial fascia and urogenital diaphragm, consists part of penis and clitoris, Bartholini glands) - deep PP (formed by urogenital diaphragm, consists Bulbourethral glands)
58
What are the consequences of injury to the bulb of penis?
Extravasation of the urine into superficial perineal space: scrotum, penis, anterior abdominal wall
59
What are the principles of the Embryology of the Reproductive System?
1) Gonads develop to: - male (by TDF): testes, seminiferous tubules, rete testes, - female: ovary, follicles, rete ovarii 2) Paramesonephric duct: - male (inhibited by MIF): appendix of testes - female: uterine tubes, uterus, cervix, upper vagina 3) Mesonephric duct: - male (by testosterone): epididymis, ductus deferens, seminal vesicle, ejaculatory duct - female: Duct of Gartner 4) Genital Tubercle: - male (by DHT): glans and body of penis - female: clitoris 5) Urogenital folds: - male (by DHT): ventral part of penis - female: labia minora 6) Labioscrotal folds: - male (by DHT): scrotum - female: labia majora
60
Where are stones in the ureters probably situated?
``` • Where the renal pelvis joins the ureter • Where the ureter crosses the pelvic inlet • Where the ureter enters the wall of the urinary bladder ```
61
Name congenital Reproductive Anomalies
1) Female Pseudointersexuality - 46, XX - +ovarian tissue, -testicular - masculinization of female genitalia - cause is Congenital Adrenal Hyperplasia 2) Male Pseudointersexuality - 46, XY - +testicular tissue, - ovarian tissue - stunted development of male external genitalia (no DHT) - cause: 5a-reductase deficiency (gene mutation): it converts testosterone to DHT, which is responsible for development of external male genitalia 3) Complete androgen insensivity - 46, XY - testes (in labia majora) + external female genitalia - female psychosocial orientation - cause: androgen receptor gene mutation
62
Which way does spermatozoa pass?
seminiferous tubules -> ductile efferent -> epididymis -> ductus (vas) deferens -> ejaculatory duct -> urethra
63
How does Erection and Ejaculation occur?
Erection: by parasympathetic -> NO releasing -> relaxation of corpus spongiosum and cavernous -> blood accumulation Ejaculation: - sympathetic stimulation of spermatozoa to move from epididymis into the ejaculatory tract - pudendal nerve stimulates bulbospongiosus and ischiocavernous muscles to semen ejection
64
What makes follicle ovulate?
Luteinizing hormone
65
Which hormone does corpus luteum produce? What does it do?
Progesterone; prevents ovulation of next follicle
66
When should physiologic herniation of midgut to umbilical ring occur? When should it return?
herniation - 6th week | return - 10th week
67
What's sliding hiatal hernia and paraesophageal hiatal hernia?
Sliding hiatal hernia—gastroesophageal junction is displaced upward as gastric cardia slides into hiatus; “hourglass stomach.” Most common type. Paraesophageal hiatal hernia— gastroesophageal junction is usually normal but gastric fundus protrudes into the thorax
68
What is Potter sequence?
Babies who can’t “Pee” in utero develop Potter sequence. ``` POTTER sequence associated with: Pulmonary hypoplasia Oligohydramnios (trigger) Twisted face Twisted skin Extremity defects Renal failure (in utero) ```
69
How does twinning occur?
Dizygotic (“fraternal”) twins arise from 2 eggs that are separately fertilized by 2 different sperm (always 2 zygotes) and will have 2 separate amniotic sacs and 2 separate placentas (chorions). Monozygotic (“identical”) twins arise from 1 fertilized egg (1 egg + 1 sperm) that splits in early pregnancy. The timing of cleavage determines chorionicity (number of chorions) and amnionicity (number of amnions) (SCAB): ƒ Cleavage 0–4 days: Separate chorion and amnion ƒ Cleavage 4–8 days: shared Chorion ƒ Cleavage 8–12 days: shared Amnion ƒ Cleavage 13+ days: shared Body (conjoined)
70
What are the clinical presentations of anterior and posterior urethral injuries?
anterior: blood in scrotum posterior: blood in abdomen, HIGH-RIDING PROSTATE

Anatomy (6 decks)

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