Abdomen Lecture Notes Pt. 1 Flashcards Preview

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Flashcards in Abdomen Lecture Notes Pt. 1 Deck (102):
1

Pain arising from the gut tube will be referred to the

Epigastrium, umbilical, or hypogastrium regions

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Lines the entire inside of the abdominal wall

Transversalis Fascia

3

Gets thick and fatty in the posterior abdominal wall

-Where the kidneys are located

Extraperitoneal layer

4

Outter covering of peritoneal cavity/inner wall of abdominal cavity

Parietal peritoneum

5

Envagination of the skin and superficial fascia that has no Camper's fascia but has a Scarpas fascia (dartos fascia)

Scrotum

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Fused together in the inguinal region

Internal oblique and transversalis fascia

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Envagination of the transversalis fascia where the spermatic cord becomes continuous with the transversalis fascia

Deep inguinal ring

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The folded under free edge of the external oblique aponeurosis

Inguinal ligament

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The transition where the internal oblique fibers begin to face downward and medial forms an arch called the

Falx inguinalis

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Internal oblique muscle fibers that are envaginated by the testes

Cremaster muscle

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The external oblique aponeurosis has a hole in it called the

Superficial inguinal ring

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The testes originates in the

Extraperitoneal layer

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Both the direct and indirect inguinal hernias exit the

Superficial inguinal ring

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What is the anatomical distinguishment between direct and indirect hernias?

Only indirect hernias pass through the deep inguinal ring

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Pass MEDIAL to the inferior epigastric artery

Direct inguinal hernias

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Pass LATERAL to the inferior epigastric artery

Indirect inguinal hernia

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If you kow it's an inguinal hernia and you place your finger on the DEEP inguinal ring and have the patient cough and you feel the hernia hit your finger in the superficial ring, then the hernia is a

DIRECT inguinal hernia

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ALL congenital inguinal hernias are

Indirect Inguinal Hernias

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Forms the scrotum in males and the labia major in females

Labiosacral fold

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Forms the gubernaculum testes in males and the round ligament of the uterus in females

Caudal Genital Ligament

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Gets to the ovary in a fold of peritoneum called the suspensatory ligament of the ovary

Ovarian artery

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Causes the dorsal part of the yolk sac to start getting internalized to become the gut tube

Lateral body folding

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Pinches off the yolk sac and fully internalizes the gut tube

Fusion of lateral body folds

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Once the gut tube forms, we get epithelium proliferation which occludes the lumen by forming the

Epithelial plug

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Apoptosis of this epithelial plug reforms the lumen of the gut tube. Failure of this process can result in either

Stenosis (partial block) or Atresia (complete block)

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Lateral body folds fuse in the midline to form the

Ventral body wall

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Failure of the lateral folds to completely fuse

Gastroschisisis

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Proximal part of vitelline duct fuses but the distal end remains open to the exterior

Vitelline sinus

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We have overlapping blood supply in the

Duodenum and transverse colon

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There are no structures found in the

Coelom

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An organ that is COMPLETELY surrounded by peritoneum is called a

Peritoneal organ

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An organ that is only PARTIALLY surrounded by peritoneum is called a

Retroperitoneal organ

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Peritoneum that COMPLETELY surrounds peritoneal organs is called

Visceral peritoneum

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Peritoneum that covers retroperitoneal organs is called

Parietal peritoneum

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Peritoneum that connects parietal and visceral peritoneum is called

Mesentary

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A ventral evagination of endoderm into the ventral mesentary forms the

Hepatic diverticulum (which forms liver, gallbladder, and bile duct)

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The ventral mesentary gives rise to the

Lesser omentum, Falciform ligament, and visceral peritoneum of the liver

38

The bile duct is found INSIDE of the

Lesser omentum (at the free edge)

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The hepatic diverticulum evaginates from the second part of the duodenum, thus the bile duct enters the duodenum in the

2nd part

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The bilary duct system is made up of which three parts?

1.) Common bile duct (hepatic diverticulum)
2.) Cystic duct (to gall bladder)
3.) Hepatic Duct (to liver)

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Has two ducts that connect to the 2nd part of the duodenum

Pancreas

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Drains into the duodenum at the same spot as the common bile duct

Ventral (major) pancreatic duct

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Sometimes the ventral pancreas splits into 2 and migrates around both sides of the duodenum forming a ring of pancreas around the 2nd part of the duodenum. This is called

Annular pancreas

44

The dorsal mesogastrium (dorsal mesentary of the stomach) is made up of which three parts?

1.) Visceral peritoneum of stomach
2.) Gastrosplenic ligament
3.) Splenorenal ligament

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Ligament between spleen and stomach

Gastrosplenic ligament

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A mesoderm organ that is NOT connected to the gut tube by a duct

Spleen

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The splenic artery travels to the spleen in the

Splenorenal ligament

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From the 2nd part of the duodenum down, what disappears?

All ventral mesentary

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When the gut moves over to the left, the visceral and parietal peritoneum fuse and the peritoneum becomes the

Fusion fascia

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Organs that started off as peritoneal but then become retroperitoneal

Secondary retroperitoneal

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Peritoneum covering secondary retroperitoneal organs

Parietal peritoneum

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Secondary retroperitoneal organs and their blood vessels are IN FRONT of

Primary retroperitoneal organs and blood vessels

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Located on the sides of the ascending and descending colon and is a bloodless plain that surgeons use to move secondary retroperitoneal organs and vessels away from the abdominal wall

White line of told

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The pathway from the greater sac (ventral) to the lesser sac (dorsal) is around the free edge of the lesser omentum which is known as the

Epiploic foramen (of Winslow)

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Located at the free edge of the lesser omentum

Hepatic triad
1.) Bile duct (anterolateral)
2.) Hepatic artery (anteromedial)
3.) Portal vein (posterior)

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What are the 5 SECONDARY retroperitoneal organs?

1.) Most of duodenum
2.) Most of pancreas
3.) Ascending colon
4.) Descending colon
5.) Upper rectum

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What are the 7 PRIMARY retroperitoneal organs?

1.) Kidney
2.) Adrenal Gland
3.) Ureter
4.) Aorta
5.) Inferior vena cava
6.) Lower rectum
7.) Anal Canal

58

The lesser omentum is made up of which two parts?

1.) Hepaticogastric ligament (thin)
2.) Hepaticoduodenal ligament (Thick)

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The epiploic foramen is not useful for

Surgical entry to the lesser sac

60

What 3 things can we cut through to gain surgical entry to the lesser sac?

1.) Lesser omentum (left entry)
2.) Gastrosplenic ligament (right entry)
3.) Gastrocolic ligament (frontal entry)

61

Fused to the greater omentum

Transverse colon and transverse mesocolon

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Part of the greater omentum in front of the transverse colon that serves as a boundary between greater and lesser sacs

Gastrocolic ligament

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Which arteries run along the lesser curvature of the stomach and anastomose with one another

Left gastric (celiac trunk) and right gastric (proper hepatic)

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Gives off the left gastroomental artery to the greater curvature and the short gastric arteries to the fundus of the stomach

Splenic artery

65

Bifurcates into an ascending branch (proper hepatic) and a descending branch (gastroduodenal)

Common hepatic artery (off celiac trunk)

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Which arteries are found on the greater curvature of the stomach where they anastamose?

Left and right gastroomental arteries

67

Gives off the right gastroomental artery and the superior pancreaticoduodenal artery

Gastroduodenal artery (branch off common hepatic)

68

Artery formed by the anastomoses between the ileocolic, right colic, left colic, middle colic, and sigmoid arteries of the colon

Marginal artery of Drummond

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The marginal artery of drummond does not sit on the

Colon

70

The marginal artery of Drummond sends branches to the colon that do not have anastomoses called

Vasa recta

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Occlusion of a vasa recta artery causes

Ischemic bowel in that section

72

The vasa recta penetrate the colon at weak spots in the wall, which are common spots for

Diverticulitis

73

Where are the three anastomoses to get from the portal system to the IVC if the liver is occluded?

1.) By upper part of rectum
2.) By esophagus
3.) Paraumbilical veins

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The anastomoses by the upper part of the rectum is an anastomosis between the

Superior rectal vein (portal) and middle and inferior rectal veins (IVC)

75

The anastomosis by the esophagus is an anstomosis between the

Left gastric vein (portal) and the esophageal and azygous veins (IVC)

76

The anastomosis with the paraumbilical veins is between the

Paraumbilical veins (portal) and the superior epigastric veins (IVC)

77

If blood is redirected throug the anastomosis by the upper part of the rectum, we see

Internal hemmorhoids

78

If blood is redirected through the esophageal anastomosis, we see

Esophageal varices

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If blood is directed through the paraumbilical anastomosis, we see

Capute medusae (bulging veins radiating from umbilicus)

80

None of the branches of the portal venous system have

Valves

81

Run along the surface of the ligamentum teres

Paraumbilical veins

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The most common procedure to create a communiation between portal and caval systems where a shunt is placed between hepatic veins (IVC) and portal veins in the liver

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

83

All the lymph channels in the abdomen drain into the

-Continues superiorly as the thoracic duct

Cysterna Chylae

84

What are the three hiatuses of the diaphragm?

1.) Aortic hiatus
2.) Cavalhiatus
3.) Esophageal hiatus

85

Sits between the two crura BEHIND the diaphragm

Aortic hiatus

86

Located in the central tendon of the diaphragm

-Where the IVC passes through

Caval hiatus

87

Opening in the right crus of the diaphrgm

-the only hiatus surrounded by skeletal muscle

Esophageal hiatus

88

Which part of the stomach does the esophagus insert into?

Cardia

89

Thickening of circular smooth muscle that marks the entrance to the duodenum

Pyloric Sphincter

90

The bile duct and major pancreatic duct empty into the

Ampulla of Vater

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The blood supply to the duodenum gets to the duodenum by first passing through the

Head of the pancreas

92

Allows superior mesenteric artery to to supply blood to the forgut if the celiac trunk is occluded

Anastomosis between superior and inferior pancreaticoduodenal arteries

93

The tail of the pancreas is directly next to the

Spleen

94

Hook off the head of the pancreas that tucks BEHIND the superior mesenteric artery and vein

Uncinate process

95

A pancreaticoduodenectomy (Whipple procedure) is made up of what three portions?

-Duodenum and head of pancreas are removed

1.) Gastrojejunostomy
2.) Pancreaticujejunostomy
3.) Hepaticojejunostomy

96

The left and right hepatic ducts form the common hepatic duct which joins with the cystic duct from the gall bladder to form the

Common bile duct

97

Occlusions of the cystic duct which cause extreme pain following meals

Gall Stones

98

Formed by the cystic duct, common hepatic duct, and liver

-Cystic artery courses right through the middle

Hepatocystic triangle

99

Fracture of the left 9th, 10th, or 11th rib can lacerate the

Spleen

100

Located in the upper left quadrant and has a feathery appearance under barium contrast

Jejunum

101

Located in the lower right quadrant and has a solid appearance under barium contrast

Ileum

102

If the splenic flexure can be seen on imaging at the same level or lower than the hepatic flexure than there is likely

Spleen enlargement

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