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Abdomen Flashcards

(103 cards)

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1
Q

Foregut

A

oesophagus to 1st part of duodenum

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2
Q

Midgut

A

2nd part of duodenum to proximal 2/3rd of transverse colon

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3
Q

Hindgut

A

distal 1/3rd of transverse colon to rectum

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4
Q

Transpyloric plane

A

L1 verterbrae
Midway through jugular notch and pubic symphysis
ninth costal cartilage
pyloric orifice (opening of stomach into duodenum)
Body of pancreas
Hila of kidney - inferior pole of left kidney, superior pole of right kidney

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5
Q

Coeliac artery

A

anterior unpaired branch from abdominal aorta at upper border of L1

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6
Q

Superior mesenteric artery

A

anterior unpaired branch from abdo aorta at lower border of L1

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7
Q

Inferior mesenteric artery

A

anterior unpaired branch from abdo aorta at LIII

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8
Q

left renal vein

A

drains left kidney, suprarenal gland and gonad on left side. Left suprarenal vein, left gonadal vein and left lumbar vein drains into left renal vein. THis then drains into IVC.

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9
Q

Left common iliac vein

A

crosses at midline at approximately L5 to join with partner on right to form IVC.

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10
Q

left lumbar vein

A

drains back and posterior abdominal wall on left side

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11
Q

portocaval anastomoses

A

inferior end of oesophagus
inferior part of rectum
where liver is in direct contact with diaphragm (bare area of liver)
where wall of GI tract in direct contact with posterior abdominal wall (retroperitoneal areas of large and small intestine)
posterior surface of pancreas

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12
Q

rectus sheath contents

A

rectus abdominis
pyramidalis
superior and inferior epigastric vessels
lower 6 thoracic nerves and accompanying branches of the posterior intercostal vessels

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13
Q

transversalis fascia - deep to transversus abdominus

A

Continuous layer of deep fascia that lines abdominal cavity and continues deep into pelvic cavity. Continuous with fascia on inferior surface of diaphragm.
Continuous posteriorly with deep fascia covering muscles of posterior abdo wall and attaches to thoracolumbar fascia.
Attaches to iliac crest.

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14
Q

Ilioinguinal nerve cutaneous supply

A

anterior surface of scrotum/labia majora, small cutaneous branch to thigh

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15
Q

intercostal nerves to abdomen

A

runs in between internal oblique and transversus abdominis muscle, appears lateral to rectus sheath and pass posterior to rectus abdominis. Midline anterior cutaneous branch passes through rectus abdominis to supply skin.

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16
Q

Arterial supply to superficial layer of anterolateral abdominal wall

A

Musculophrenic artery - branch of internal thoracic

Superior epigastric artery and superficial circumflex iliac artery - both branches of femoral artery

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17
Q

Arterial supply to deep layer of abdominal wall

A

Superior epigastric artery
Intercostal arteries T10-T11 and subcostal artery T12
Inferior epigastric artery and deep circumflex iliac artery - both branches of external iliac artery

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18
Q

superior and inferior epigastric arteries

A

passes posteriorly to rectus abdominis throughout their course and anastomose with each other

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19
Q

lymphatic drainage of anteriolateral abdo wall

A

Superficial
superior to umbilicus - axillary nodes
below umbilicus - superficial inguinal nodes
Deep
Parasternal nodes, lumbar nodes and external iliac nodes

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20
Q

layers of processus vaginalis

A

transversalis fascia forms deepest covering
second covering - internal oblique
most superficial -external oblique
transversus abdominis covering not acquired because PV passes under arching fibers of this muscle

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21
Q

processus vaginalis

A

forms basic structure of inguinal canal

anterior to gubernaculum

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22
Q

inguinal canal

A 
4cm long. 
Contents: 
Genital branch of genitofemoral nerve
spermatic cord (men), round ligament (women)
Ilioinguinal nerve
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23
Q

deep inguinal ring

A

mid-inguinal point
lateral to inferior epigastric vessels
continues as internal spermatic fascia of spermatic cord

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24
Q

superficial inguinal ring

A

superior to pubic tubercle
Triangular opening in the aponeurosis of external oblique. Apex pointing superolaterally and base formed by pubic crest. Two side of triangle attached to pubic symphysis and pubic tubercle.
continues as external spermatic fascia.

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25
borders of inguinal canal
anterior - aponeurosis of external and internal oblique posterior - transversalis fascia and conjoint tendon roof - transversus abdominis and internal oblique muscles floor - inguinal ligament
26
Contents of spermatic cord
``` ductus deferens artery to ductus deferens (from inferior vesical artery) testicular artery (from abdominal aorta) testicular veins cremasteric artery and veins genital branch of genitofemoral nerve sympathetic and visceral afferent fibers lymphatics ```
27
Fascia of spermatic cord
internal spermatic fascia - deepest, from transversalis fascia cremasteric fascia - internal oblique external spermatic fascia - external oblique
28
cremasteric muscle
supplied by genital branch of genitofemoral nerve. | Sensory fibres enter spinal cord at L1
29
Hesselbach triangle boundaries
inferiorly inguinal ligament laterally inferior epigastric vessels medially rectus abdominis
30
Omental bursa
smaller subdivision of peritoneal cavity posterior to stomach and liver, connected to greater sac through epiploic foramen
31
Epiploic foramen
anteriorly - portal vein, hepatic artery proper, bile duct posteriorly - IVC superiorly - caudate lobe of liver inferiorly - first part of duodenum
32
greater omentum
derived from dorsal mesentery from greater curvature of stomach and first part of duodenum draping over transverse colon and coils of jejunum and ileum contains two arteries and accompanying veins - right and left gastro-omental vessel between this double-layered peritoneal apron
33
lesser omentum
lesser curvature of stomach and first part of duodenum to inferior surface of liver. derived from ventral mesentery Divided into medial hepatogastric ligament - between stomach and liver lateral hepatoduodenal ligament - between duodenum and liver Right and left gastric vessels are in between the layers of lesser omentum
34
Oesophagus
25cm long, from C6 behind cricoid cartilage to cardia of stomach (around T11) vagus nerve through T10 of diaphragm - anterior trunk from left vagus, posterior trunk from right vagus
35
Regions of stomach
cardia - opening of oesophagus into stomach fundus - area above level of cardial orifice body - largest region pyloric - pyloric antrum and pyloric canal and is the distal end of stomach
36
Arterial supply of oesophagus
branches from left gastric (from coeliac trunk) | branches from left inferior phrenic artery (from abdo aorta)
37
arterial supply to stomach
lesser curvature: left gastric artery from celiac trunk right gastric artery from hepatic artery proper greater curvature: right gastro-omental artery from gastroduodenal artery left gastro-omental artery from splenic artery posterior gastric artery from splenic artery (not always present)
38
duodenum
20-25cm long above level of umbilicus, adjacent to head of pancreas retroperitoneal except for its beginning, which is connected to liver by hepatoduodenal ligament
39
4 parts of duodenum
superior part descending inferior ascending
40
Superior part of duodenum
pyloric orifice of stomach to neck of gallbladder. just right of L1 and passes anteriorly of bile duct, gastroduodenal artery, portal vein and IVC. Most duodenal ulcers occur here.
41
2nd part (Descending part) of duodenum
Right of midline and from neck of gallbladder to lower border of LIII. Anterior surface crossed by transverse colon, posterior to it is right kidney, and medial is head of pancreas. Contains major duodenal papilla (entrance for bile and pancreatic ducts) and minor duodenal papilla (entrance for accessory pancreatic duct).
42
inferior part (3rd part) of duodenum
longest section, crossing IVC, aorta and vertebral column. Crossed anteriorly by SMA and SMV.
43
Ascending part (4th part) of duodenum
passes upward and left of aorta to approximately upper border of LII and terminates at duodenojejunal flexure.
44
arterial supply to duodenum
branches of gastroduodenal artery | first jejunal branch of SMA
45
Jejunum
proximal 2/5ths of small intestine, larger in diameter and thicker wall than ileum. walls has plicae circulares. less prominent arterial arcades and longer vasa recta arterial supply - jejunal arteries from SMA
46
Ileum
distal 3/5ths of small intestine. Thinner walls, fewer and less prominent mucosal folds, shorter vasa recta, more arterial arcades. arterial supply - ileal arteries from SMA and ileal branch from ileocolic (from SMA)
47
duodenal ulcers
posterior - erode into gastroduodenal artery or more commonly onto posterior superior pancreaticoduodenal artery anterior - peritoneal cavity causing peritonitis
48
appendix
arterial supply - anterior cecal artery, posterior caecal artery and appendicular artery. All branches of ileocolic artery from SMA
49
colon structure locations
ascending and descending are secondarily retroperitoneal | transverse and sigmoid are intraperitoneal
50
arterial supply to ascending colon
colic branch from ileocolic (from SMA) anterior cecal artery, posterior caecal artery both from ileocolic (from SMA) right colic artery from SMA
51
arterial supply to transverse colon
right colic from SMA middle colic from SMA left colic from IMA
52
arterial supply to descending colon
left colic from IMA
53
arterial supply to sigmoid
sigmoidal artery from IMA
54
Rectosigmoid junction
level of vertebra S3, rectum is a retroperitoneal structure
55
Arterial supply to rectum and anal canal
superior rectal artery from IMA middle rectal artery from internal iliac artery inferior rectal artery from internal pudendal artery (from internal iliac artery)
56
Visceral surface of liver in contact with
oesophagus,, right anterior part of stomach, superior part of duodenum, lesser omentum, gallbladder, right colic flexure, right transverse colon, right kidney and right suprarenal gland
57
Ligaments of liver
Liver attached to anterior abdominal wall by falciform ligament, except for a small area against diaphragm (bare area of liver). Hepatoduodenal ligaement Hepatogastric ligament Anterior and posterior coronary ligaments - attached to diaphragm.
58
Bare area of liver
Anterior boundary - anterior coronary ligament Posterior boundary - posterior coronary ligament Where coronary ligaments come together laterally they form right and left triangular ligaments
59
Quadrate lobe of liver
Visible on anterior part of visceral surface, bounded on left by fissure for ligamentum teres and right by gallbladder. Functionally related to left lobe of liver
60
Caudate lobe of liver
Visible on posterior part of visceral surface. Bounded on left by fissure for ligamentum venosum and right by IVC
61
arterial supply of liver
right and left hepatic artery - branch of hepatic artery proper - branch of common hepatic artery from coeliac trunk
62
arterial supply of gallbladder
cystic artery from right hepatic artery
63
Pancreas
Lies mostly posterior to the stomach. Extends from duodenum (on R) to spleen (on L) Mostly retroperitoneal except for some parts of its tail. Develops from ventral and dorsal buds from foregut. Ventral - head and uncinate Dorsal - head, neck and body.
64
Parts of pancreas
Head, uncinate process, neck, body and tail
65
Head of pancreas
C-shaped concavity of duodenum
66
Uncinate process of pancreas
passes posterior to superior mesenteric vessels
67
Neck of pancreas
anterior to superior mesenteric vessels. | SMV and splenic veins join to form portal vein behind neck of pancreas
68
Tail of pancreas
passes between layers of splenorenal ligament
69
arterial supply to pancreas
gastroduodenal artery (branch of common hepatic artery) inferior pancreatic artery (branch of splenic artery) inferior pancreaticoduodenal artery (branch of SMA)
70
Bile duct relative structure
Lies to the right of hepatic artery proper, and usually to the right/anterior of portal vein. Continues inferiorly and passes posterior to superior part of duodenum
71
Spleen
Develops from dorsal mesentery | From rib 9 to 10
72
Spleen connected to
greater curvature of stomach by gastrosplenic ligament which contains short gastric and gastro-omental vessels left kidney by splenorenal ligament which contains splenic vessels
73
arterial supply to spleen
splenic artery (a branch of coeliac trunk)
74
Liver
8 lobes, Caudate lobe = Segment I and moves clockwise. | Principal plane = parasagittal plane across IVC and gallbladder
75
Coeliac trunk
anterior branch of abdominal aorta - anterior to L1. | Divides into left gastric, splenic and common hepatic arteries
76
Left gastric artery
Smallest branch of coeliac trunk. Has oesophageal branches to abdo part of oesophagus. Descends along lesser curvature of stomach and anastomose with right gastric artery.
77
Splenic artery
largest branch of coeliac trunk. Travels to the left along superior border of pancreas, travels in splenorenal ligament and enters hilum of spleen. Branches into short gastric arteries (fundus of stomach) Branches into left gastro-omental artery which runs along greater curvature of stomach and anastomose with right gastro-omental artery
78
Common hepatic artery
Divides into 2 terminal branches - hepatic artery proper and gastroduodenal artery
79
Hepatic artery proper
runs to left of bile duct and anterior to portal vein, and divides into left and right hepatic artery
80
Gastroduodenal artery
Give off posterior superior pancreaticoduodenal artery | Terminates into 2 branches - right gastro-omental artery and anterior superior pancreaticoduodenal artery
81
Superior mesenteric artery
anterior branch of abdominal aorta, lower part of LI Crossed anteriorly by splenic vein and neck of pancreas Posterior to it - left renal vein, uncinate process and inferior part of duodenum. First branch - inferior pancreaticoduodenal artery left branches - jejunal and ileal arteries right branches - middle colic, right colic and ileocolic.
82
Inferior mesenteric artery
anterior branch of abdominal aorta, around LIII. | Branches - left colic, sigmoid and superior rectal artery
83
Portal vein
Union of splenic vein and superior mesenteric vein posterior to neck of pancreas at level LII.
84
Tributaries of portal vein
right and left gastric veins cystic veins paraumbilical veins
85
Tributaries of splenic vein
short gastric veins left-gastro-omental vein pancreatic vein inferior mesenteric vein (usually)
86
portosystemic anastomoses
gastro-oesophageal junction at stomach - left gastric vein (portal) with azygos system (caval) anus - superior rectal vein (portal) with middle and inferior rectal veins (systemic) umbilicus - paraumbilical (portal) with veins of anterior abdominal wall. Causes caput medusae.
87
Sympathetic trunks route
As they pass through neck, lie posterior to carotid sheath. In upper thorax, anterior to necks of ribs. Lower thorax, lateral aspect of vertebral bodies. Abdo, anterolateral to lumbar vertebral bodies. In pelvis, anterior to sacrum. The two trunks come together anterior to coccyx to form ganglion impar.
88
sympathetic trunk ganglias
cervical - 3 thoracic - 11/12 lumbar - 4 sacral - 4/5
89
Splanchnic nerves
thoracic, lumbar and sacral - sympathetic | pelvic - parasympathetic
90
thoracic splanchnic nerves
greater - T5-T9 - to coeliac ganglion lesser - T10-11 - to aorticorenal ganglion least - T12 - to renal plexus
91
lumbar splanchnic nerves
usually 2 to 4 | passes from lumbar part of trunk to prevertebral plexus
92
sacral splanchnic nerves
pass from sacral part of trunk and enter inferior hypogastric plexus, which is an extension of prevertebral plexus into the pelvis.
93
Pelvic splanchnic nerves (parasympathetic)
Originate from anterior rami of S2-4 to inferior hypogastric plexus. Innervates the hindgut.
94
Abdominal prevertebral plexus
3 major divisions - coeliac, aortic and superior hypogastric plexus. Receives: preganglionic parasympathetic and visceral afferent fibers from vagus nerves thoracic and lumbar splanchnic nerves pelvic splanchnic nerves
95
Boundaries of posterior abdominal region (muscle)
Medially - psoas major and minor Laterally - quadratus lumborum Inferior - Iliacus Superior - diaphragm
96
Psoas major
Attachment - lateral surface of bodies of T12 and L1-5 vertebrae, travels under inguinal ligament to lesser trochanter of femur Innervation - Anterior rami of L1 to L3 Function - flex thigh at hip joint
97
Psoas minor
Attachment - lateral surface of bodies of T12 and Li vertebrae. Insertion - pectineal line of pelvic brim Innervation - anterior rami of L1 Function - weak flexion of lumbar vertebral column
98
Quadratus lumborum
Origin - transverse process of L5, iliolumbar ligament and iliac crest Insertion - transverse process of L1 -4 and inferior border of rib 12 innervation - anterior rami of T12 and L1-4 Function - depress and stabilise rib 12 some lateral bending of trunk
99
Iliacus
Origin - upper 2/3rd of iliac fossa and upper lateral surface of sacrum insertion - lesser trochanter of femur Innervation - femoral nerve (L2-4) function - flexion of thigh at hip joint
100
Diaphragm phrenic nerve
Right phrenic nerve passes through with IVC | Left phrenic nerve passes through muscular part of diaphragm just anterior to central tendon on left side
101
Arterial supply to diaphragm
Superiorly, musculophrenic and pericardiocophrenic arteries (branches of internal thoracic) and superior phrenic artery (branch of thoracic aorta) Inferiorly, inferior phrenic artery (branch of abdo aorta)
102
Transpyloric plane - between jugular notch and pubic symphysis
``` L1 vertebrae THrough ends of ninth costal cartilage Beginning and upper limit of end of duodenum Hila of kidneys Neck of pancreas Origin of SMA from aorta ```
103
Surface anatomy of kidneys
Left slightly higher than right, up to rib 11 whereas right reaches only rib 12 Lower poles around level of disc between L3-L4

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