Abdomen (SEM 2) Flashcards by Elise Kim

2 layers of subcutaneous tissue of anterior abdominal wall

superficial = fatty (camper’s) fascia

membranous (scarpa’s) fascia
-continues as collet’ fascia over penis/scrotum/labia major

How well did you know this?

Not at all

Perfectly

external oblique

internal oblique

transversus abdominis

EO -most superficial

origin = outer 5-12th ribs
lower costal nerves/subcostal nerve
contralateral rotation

origin = inguinal lig/iliac crest
inserts = lower margin of 10-12th ribs / lateral inguinal ligament
ipsiolateral rotation
lower costal nerves/subcostal/L1 spinal

inner surface of 7-12th cartilage ribs
same nerve supply as IO
compresses abdominal contents

How well did you know this?

Not at all

Perfectly

L1 spinal nerve gives rise to

iliohypogastric
ilioinguinal nerves

supplies internal oblique and transverses abdominis

How well did you know this?

Not at all

Perfectly

surgical importance of linea alba

no important nerves/vessels - common place for incision

How well did you know this?

Not at all

Perfectly

rectus sheath

made up of external oblique, internal oblique and transversus abdominis

contains rectus abdominis muscle

How well did you know this?

Not at all

Perfectly

rectus abdominis

linea alba down middle
semilunaris on lateral side

vertical muscle fibre orientation

origin: pubis/pubic symphysis
insertion: xiphoid/cartilage processes 5-7

How well did you know this?

Not at all

Perfectly

arcuate line

what is present above but not below

line found L1 below umbilicus

posterior rectus sheath only above arcuate line (anterior still present below)

How well did you know this?

Not at all

Perfectly

what arteries supply the anterior abdominal wall above/below umbilicus

above = superior epigastric (branch of internal thoracic)

below = superficial epigastric (branch of femoral artery after inguinal ligament)

How well did you know this?

Not at all

Perfectly

what is the inferior epigastric artery a branch of

external iliac artery

How well did you know this?

Not at all

Perfectly

transversus abdominis plane (TAP) blocks

Anesthetists are commonly insert TAP under ultrasound guidance to provide post-operative anesthesia to nerves of the anterior abdominal wall

How well did you know this?

Not at all

Perfectly

inguinal ligament -where

what is it formed by

ASIS - pubic tubercle

formed by aponeurosis of external oblique

How well did you know this?

Not at all

Perfectly

boundaries of inguinal canal

found in the half of the inguinal ligament closest to pubis

floor = inguinal ligament

anterior wall = external oblique aponeurosis (+ internal oblique, laterally)

posterior wall = conjoint tendon and transversalis fascia

roof = overarching fibres of internal oblique and transversus abdominis

How well did you know this?

Not at all

Perfectly

when does inguinal canal close

contraction of internal oblique/ transversus abdominis (roof)

these are innervated by L1 fibres (iliohypogastric and ilioinguinal)

How well did you know this?

Not at all

Perfectly

structures which enter the deep/internal inguinal ring of canal

spermatic cord

vas deferens
testicular artery
lymphatics
veins of pampiniform plexus

-genital branch of genitofemoral nerve

(ilioinguinal nerve does not enter via deep ring)

How well did you know this?

Not at all

Perfectly

structures that exit out of the superficial/external inguinal ring of canal

ilioinguinal nerve

genital branch of genitofemoral nerve

spermatic cord/ round ligament

How well did you know this?

Not at all

Perfectly

spermatic cord:

3 x CANT

3 coverings from muscle:

external oblique
cremasteric muscle
internal oblique

3 arteries from internal iliac artery:

testicular
artery to vas deferens (from superior vesicle artery -internal iliac)
cremasteric (branch of inferior epigastric- external iliac)

3 nerves:

genital branch of genitofemoral (cremasteric)
parasympathetic (point)
sympathetic (shoot)

3 tubes:

vas deferens
pampiniform plexus of veins
lymphatics

How well did you know this?

Not at all

Perfectly

where does spermatic cord end

testis

How well did you know this?

Not at all

Perfectly

direct and indirect inguinal hernia

inferior epigastric artery marks medial border of deep inguinal ring

if hernia is

medial to the artery = direct
lateral = indirect

direct (acquired)

does not transverse the entire inguinal canal (usually only its medial part)
almost never enters scrotum
less likely to strangulate blood supply

indirect (congenital)

transverse the entire inguinal canal
exits through superficial inguinal canal–> scrotum = inguino-scrotal
strangulation –> bowel ischaemia

How well did you know this?

Not at all

Perfectly

difference between femoral and inguinal hernia

inguinal hernia sac is ABOVE pubic tubercle and through the inguinal canal

femoral hernia is BELOW pubic tubercle (not through inguinal canal)

inguinal hernias more common

women more likely to get femoral

men more likely to get inguinal (testis descend through inguinal canal)

How well did you know this?

Not at all

Perfectly

conjoint tendon

Combined fibres from lower internal oblique and aponeurosis of transversus abdominis muscles to the pubic crest

nerve supply = ilioinguinal nerve (L1)

forms medial/roof part of posterior wall of inguinal canal

How well did you know this?

Not at all

Perfectly

falciform ligament

Study These Flashcards

double fold of peritoneum

Attaches anterior surface of liver to anterior abdominal wall

derived from ventral mesentery (foetal)

lower end wraps around the round ligament of liver (remnant of foetal umbilical vein)

difference between intraperitoneal and retroperitoneal

Study These Flashcards

retroperitoneal = only parietal covering ANTERIOR surface
(primary and secondary)

intraperitoneal structures = enveloped posterior and anterior by visceral peritoneum

retroperitoneal structures

Study These Flashcards

SADPUCKER

S- uprarenal (adrenal) glands
A- orta/IVC
D- uodenum (except proximal 2cm)
P- ancreas (except tail)
U- reters
C- olon (only ascending and descending)
K- idneys
E- (o)esophagus
R- ectum (only lateral 2/3rds)

omentum and mesentery

Study These Flashcards

omentum = SHEETS of visceral peritoneum

greater(4): greater curvature–> transverse colon (policeman)

lesser(2): lesser curvature–> liver

mesentery = double layer of visceral connecting intraperitoneal organs to POSTERIOR abdominal wall

transverse mesocolon
mesentery of small intestine
sigmoid mesocolon

divisions of peritoneal cavity

transverse mesocolon: infra colic and supracolic mesentery of small intestine subdivides infracolic into left/right

differences of mesentery of jejunum and ileum

jejunum - less fat - thicker diameter - longer vasa recta - fewer arcades ileum - more fat - thinner diameter - shorter vasa recta - more arcades

Sigmoid volvulus

sigmoid colon twists on mesentery ---> cant pass wind ---> distended stomach

how is the position of duodenojejunal junction maintained

by a suspensory ligament (the suspensory ligament of Trietz) peritoneal fold attached to underside of diaphragm bleeding in GIT is divided into - upper (proximal to ligament) - lower (distal to ligament)

What is a gridiron (McBurney’s incision)

For appendectomy Begins 2/5cm above ASIS ---> lateral 1/3rd way to umbilicus

what is found on the free border of lesser omentum

Hepatodudenal ligament 3 structure found in this free edge - common bile duct (cystic duct+common hepatic duct) - portal vein - hepatic artery pringle's manoeuvre = clamping this

what level is coeliac trunk | superior and inferior mesenteric arteries

coeliac - T12 SMA- L1 IMA - L3

venous drainage of stomach

mainly by splenic vein--> hepatic portal vein

Incisura angularis

angle on lesser curvature side of pyloric part of stomach

how many parts of duodenum and how many parts are derived from foregut

2 out of 4 total parts 1st part = intraperitoneum

what part of duodenum = peptic ulceration occur mostly in what is Kocherisation

1st part this can perforate into peritoneal cavity (because intraperitoneal)---> peritonitis anterior ulcers tend to perforate posterior ulcers tend to bleed Mobilising duodenum before performing other procedures

sliding and para-oesophageal(rolling) hiatal hernia

sliding = cardia and fundus of stomach---> hiatus (T10) -common regurgitation-->Barretts rolling = cardia remains in place, pouch of peritoneum containing fundus extends through the hiatus anterior to oesophagus -rare regurgitation (More hazardous)

branches of SMA

Jejunal and ileal arteries Ileocolic artery Right colic artery Middle colic artery

branches of IMA

marginal artery of drummound : Connects the IMA and SMA --> arc of Riolan Left colic artery Sigmoidal arteries Superior rectal artery (continuation of IMA)

what ligaments do the peritoneal reflections that pass from the surface of the liver onto the underside of the diaphragm form

coronary ligament left and right triangular ligaments

What causes the colonic wall to have a sacculated appearance

sacculated appearance = haustra tone of Taeniae coli = Longitudinal muscle of colon is confined to 3 thin bands

Anorectal junction derived from what above and below

pectinate line Above: derived from embyronic hindgut Below: from ectoderm of proctodeum lined by non-keratinised stratifeid squamous epithelium (anal pecten) smooth

Anal lymphatic drainage

pararectal lymph nodes --> inferior mesenteric nodes Lymph from lower aspect of rectum drains directly into internal iliac lymph nodes

where is a vertebral fracture common

between T12 and L1 because of the pressure on L1

trapezius

``` Origin = occipital + C7-T12 insert = spine of scapula ``` accessory nerve

latissimus dorsi

spinous processes T12-L5/iliac crest ---> floor of inter tubercular groove of humerus thoracodorsal nerve (C6-8)from posterior cord of brachial plexus shoulder adduction/extension internal rotation of arms

erector spinae

iliocostalis longissimus spinalis

Quadratus lumborum

origin: posterior iliac crest insertion: inferior border of 12th rib + transverse process L1-4 stabilises 12th rib/lateral flexion/ depression of 12 the ib and diaphragm for expiration lateral to psoas major lateral arcuate ligament over it in diaphragm lumbar arteries from aorta

psoas major | psoas minor

major -origin: T12-L5 -insertion: lesser trochanter (is one of the iliopsoas muscle with iliacus) minor (anterior to major) - origin:T12/L1 vertebrae - insertion: iliopectineal arch on pelvis

what could be mistaken as AAA

abdominal aorta is posterior to stomach/pancreas if there is a tumour on these organs it will transmit the pulse from the aorta and easily mistaken as abdominal aortic aneurysm (bulge caused by weakness of blood vessel) pulsations of a large aneurysm would be felt left from midline and easily moved side to side AAA rupture mortality rate = 90%

branches of coeliac trunk

splenic left gastric hepatic

For renal transplantation which artery is preferred for anastomosis with the renal artery of the donor’s kidney

external iliac artery because it is more superficial

at what lumbar vertebrae do the common iliac veins join --> IVC

L5 | posterior to aorta, to the right

Abdomen (SEM 2) Flashcards

(52 cards)