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Block 1 > Abdominal Anatomy > Flashcards

Abdominal Anatomy Flashcards

1
Q

At what vertebral level is the transpyloric plane?

A

L1

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2
Q

At what vertebral level is the subcostal plane?

A

L3

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3
Q

At what vertebral level is the supracristal plane?

A

L4

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4
Q

At what vertebral level is the transtubercular plane?

A

L5

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5
Q

The abdominal cavity extends from

A

The diaphragm to the pelvic girdle

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6
Q

Which 3 lines separate the 9 regions of the abdomen?

What are their levels?

A

Midclavicular lines

Subcostal plane (L3)

Transtubercular plane (L5)

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7
Q

What are the 9 regions of the abdomen?

A

Right/left hypochondrium

Right/left flank

Right/left ilaic fossa

Epigastric

Umbilical

Pubic

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8
Q

Name the muscles of the abdominal wall from superficial to deep

A

Rectus abdominus

External oblique

Internal oblique

Transversus abdominus

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9
Q

What structure does the external oblique, internal oblique insert into?

A

Linea alba (at the midline)

Covered by aponeurosis

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10
Q

Which muscle forms the inguinal ligament?

A

Free border of the external oblique

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11
Q

Where does the inguinal ligament join to at either end?

A

ASIS

Pubic tubercle

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12
Q

Why is a midline incision to the abdomen not necessarily a good thing?

A

The linea alba has a poor bloody supply = bad for wound healing = predisposition to herniation

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13
Q

Where is the origin of the internal oblique?

A

Lower few ribs

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14
Q

Between which muscles is the neurovascular plane of the abdomen?

A

Between the internal oblique and transversus abdominus

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15
Q

What are the collective functions of the abdominal wall muscles?

A

Support

Movement

Intra-abdominal pressure- peeing, pooing, coughing, birthing

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16
Q

Name the layers of the abdominal wall from superficial to deep

A

Skin

Superficial fascia

External oblique

Internal oblique

Transvresus abdominus

Transversalis fascia

Parietal peritoneum

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17
Q

Above the arcuate line, where is the rectus abdominus muscle?

A

In the rectus sheath, made from the tendons of the other 3 muscles

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18
Q

Where is the arcuate line?

What changes at this point?

Why is this important?

What then sits behind the rectus abdominus?

A

Around the umbilical area

The rectus abdominus moves behind all 3 aponeurosis of the flat abdominal wall muscles

Allows the rectus abdominus to move away from the midline during pregnancy

Transversalis fascia then sits closest to the rectus abdominus at the back

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19
Q

What arteries/veins are found in the rectus sheath?

A

Inferior epigastric artery

Inferior epigastric vein

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20
Q

Which arteries meet in the rectus sheath?

A

Superior and inferior epigastric arteries

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21
Q

Why are the superior and inferior epigastric arteries important in a patient with a narrowed aorta?

A

They unite the subclavian artery to external iliac vein - forms an arterial shunt

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22
Q

What is incised in a midline incision?

A

Linea alba

Avascular tissue

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23
Q

What is incised in a paramedian incision?

What muscle would you see either side of the midline?

A

Rectus sheath

Muscle displaced laterally to spare nerves

Rectus abdominus

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24
Q

When is a Gridiron incision at McBurney’s point used?

Which nerve is at risk?

How do you find McBurney’s point?

A

Appendectomies

Ilioinguinal and iliohypogastric nerves are at risk

One-third of the distance between the right ASIS and umbilicus

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25
Q

What is at high risk of damage in a subcostal (Kocher) incision?

A

Superior epigastric artery

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26
Q

A surgeon makes a midline incision of the abdomen. What structures does he come across in order from superficial to deep?

A

Skin

Subcutaneous fatty layer (Camper’s fascia)

Membranous fascia (Scarpa’s)

Linea alba

Transversalis fascia

Preperitoneal fat

Parietal peritoneum

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27
Q

Where does abdominal wall lymphatic fluid drain to?

A

Axillary and inguinal lymph nodes

4 points from the umbilicus

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28
Q

What is the gut tube covered in?

A

A layer of tissue called the peritoneum

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29
Q

When is a structure intra-peritoneal?

A

When it is covered in peritoneum

e.g. gut tube

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30
Q

When is a structure retro-peritoneal?

A

When it sits behind the peritoneum

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31
Q

List the retro-peritoneal structures

A

S = Suprarenal (adrenal) glands

A = Aorta/IVC

D = Duodenum (second and third segments)

P = Pancreas

U = Ureters

C = Colon (ascending and descending only)

K = Kidneys

E = Esophagus

R = Rectum

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32
Q

What is the mesentery?

A

A fold of peritoneum suspending an organ from the abdominal wall

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33
Q

What is a secondary retroperitoneal structure?

A

Intraperitoneal structure that later becomes retroperitoneal

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34
Q

Name the 3 main arteries supplying the gut tube

What vertebral levels are they found out?

What regions do they supply?

A

Coeliac trunk T12 foregut

Superior mesenteric artery L1 midgut

Inferior mesenteric artery L3 hindgut

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35
Q

Which nerves supply the foregut?

Where is their dermatome?

A

T5 - T9

Epigastric region -

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36
Q

Which nerves supply the midgut?

Where is their dermatome?

A

T10-T11

Umbilical region

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37
Q

Which nerves supply the hindgut?

Where is their dermatome?

A

T12-L1

Pubic region

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38
Q

Which dermatome covers the belly button?

A

T10

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39
Q

Which spinal nerve covers the inguinal ligament?

A

L1

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40
Q

Which mesentery contains the neurovascular supply to the gut?

A

Dorsal mesentery

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41
Q

At which vertebral level does the oesophagus start?

A

C6/7

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42
Q

What type of muscle form the oesophagus?

A

Upper third = skeletal muscle

Lower two thirds = smooth muscle

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43
Q

What does the oesophagus run posterior to?

A

Trachea

Left atrium of the heart

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44
Q

At what vertebral level is the oesophageal hiatus?

A

T11-12

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45
Q

At what vertebral level does the aorta pass through the diaphragm?

A

T12

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46
Q

At what vertebral level is the pyloric sphincter of the stomach?

What else can be found here?

A

L1

Renal arteries

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47
Q

Between what vertebral levels does the duodenum run?

A

L1-L3

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48
Q

What type of mesentery does the foregut have?

A

Ventral and dorsal mesentery

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49
Q

What type of mesentery does the midgut and hindgut have?

A

Dorsal mesentery

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50
Q

Where is the lesser omentum?

A

The peritoneum between the stomach and the liver

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51
Q

What structures can be found in the free lower edge of the lesser omentum?

A

Common bile duct

Hepatic artery

Portal vein

52
Q

Where is the greater omentum?

A

Large loop of dorsal mesentery that hangs off the greater curvature of the stomach, covers the small intestine, then loops back up to attach to the transverse colon

53
Q

Draw out the branches of the coeliac trunk

A

Draw it good

54
Q

Where is the marker for an upper vs. lower GI bleed?

What else does this mark?

A

Ligament of Treitz

The duodeno-jejunal flexure

55
Q

Which artery is at risk of perforation with a duodenal ulcer?

A

Gastroduodenal artery

56
Q

Which arteries supply the duodenum?

A

Superior pancreaticoduodenal artery - from the gastroduodenal artery off the coeliac trunk

Inferior pancreaticoduodenal artery - off the SMA

57
Q

Describe the pain pattern of appendicitis

A

Early visceral pain refers to the umbilical region

Later stage somatic pain refers to the right iliac fossa

58
Q

What is the blood supply to the appendix?

A

Appendicular artery from ileocolic artery of SMA

59
Q

Which portion of the large intestine refers pain to the umbilical region?

A

Ascending colon

60
Q

Which portion of the large intestine refers pain to the pubic region?

A

Descending colon

Sigmoid colon

Rectum

61
Q

Draw out the branches of the superior mesenteric artery

What vertebral level?

A

Draw it good

L1

62
Q

Draw out the branches of the inferior mesenteric artery

What vertebral level?

A

Draw it good

L3

63
Q

What is the cysterna chyli?

A

Dilated sac at the lower end of the thoracic duct

64
Q

What is the thoracic duct?

Where does it drain to?

A

A large lymphatic duct that drains most of the abdomen and lower portion of the body

It drains into the systemic circulation at the angle of the left subclavian and internal jugular veins as a single trunk, at the commencement of the brachiocephalic vein

65
Q

Why can upper GI cancers cause a left supraclavicular lymphadenopathy?

A

Lymph drains upwards towards the left subclavian and internal jugular veins. There are valves that prevent backflow

Mets of GI cancers can block the thoracic duct, causing an enlarged Virchow’s node

66
Q

Where does the rectum receive its blood supply from?

A

IMA

Internal iliac artery

67
Q

Where in the rectum is the origin point for classic haemorrhoids?

A

Internal venous plexus

68
Q

Where in the rectum is the origin point for external haemorrhoids?

A

External venous plexus

69
Q

Pelvic organs covered in peritoneum refer pain to…

A

T11-L2

Visceral sensory nerves travel alongside sympathetic nerves originating from T11- L2

70
Q

Pelvic organs below the peritoneum refer pain to..

A

S2-4

Visceral sensory nerves travel alongside parasympathetic nerves originating from S2-S4

71
Q

Haemorrhoids are classically reported at what positions?

A

3, 7, 11 o’clock positions

72
Q

Which 2 types of nerves stop you from pooing?

A

Sympathetic - contracts internal sphincter

Somatic (pudendal S2-4) - contracts external sphincter

73
Q

Which nerve causes you to poo?

A

Parasympathetic (pelvic splanchnic nerve S2-4) - relaxes internal sphincter and contracts rectal wall

74
Q

What are the boundaries between the foregut, midgut and hindgut?

A

FOREGUT
Mouth –> major duodenal papillae (2nd part of duodenum)

MIDGUT
Major duodenal papillae –> 2/3rds along the transverse colon

HINDGUT
2/3rds along the transverse colon –> upper anal canal

75
Q

What does the falciform ligament contain in utero?

What does this turn into in adults?

A

Contains the umbilical vein

Ligamentum teres in adults

76
Q

What is the spleen derived from in utero?

A

Mesodermal derivative

77
Q

What is found in the ventral mesentery in utero?

A

Liver

Gallbladder

Part of pancreas

78
Q

What is found in the dorsal mesentery in utero?

A

Spleen

Part of pancreas

79
Q

Describe the rotation of the stomach and liver in utero

What space does this create?

A

Stomach rotates to the right 90 degrees and clockwise 90 degrees

Liver moves into the right hypochondrium

Creates the lesser sac - region sitting behind the stomach

80
Q

What mesentery does the lesser omentum form from?

A

Ventral mesentery

81
Q

What mesentery does the greater omentum form from?

A

Dorsal mesentery

82
Q

What is the only route in and out of the lesser sac?

A

The epiploic foramen

83
Q

The pancreas and duodenum in adults are _______ ______peritoneal

A

Secondarily retroperitoneal

84
Q

What are the paracolic gutters?

Why are they clinically important?

A

Channels that run up the lateral side of the ascending and descending colon from the pelvic cavity to the diaphragm.

Provide a potential route for infection to spread.

When a patient lies down fluid will accumulate on their back

85
Q

Name the mesentery between the stomach and the liver

A

Lesser omentum

86
Q

Where does the greater omentum go between?

A

The stomach and the transverse colon

87
Q

Where is the greater sac?

A

Everything in the peritoneum except for the lesser sac

88
Q

Where is the supracolic compartment of the greater sac?

A

Above the transverse colon and in front of the greater omentum

89
Q

Where is the infracolic compartment?

A

Below the transverse colon and behind the greater omentum

90
Q

Where is the surface anatomy marking for the superior surface of the liver?

A

5th rib at midclavicular line

Follows upper limit of diaphragm

91
Q

What is the bare area of the liver?

Why is there a bare area of the liver?

A

An area where the liver touches the diaphragm with no mesentery attached

The liver grows so fast in the ventral mesentery that it grows out the top of it with no mesentery covering it

92
Q

Name the 4 anatomical lobes of the liver

A

Left

Right

Caudate (top middle)

Quadrate (bottom middle)

93
Q

What ‘passes through’ the substance of the liver?

A

The IVC

94
Q

What structures can be found in the porta hepatis?

A

Portal vein

Bile duct

Hepatic artery

Autonomic nerves

95
Q

How many segments of the liver are there?

Describe the blood supply to the segments

Why is this useful?

A

8 functionally independent segments of the liver

Has its own hepatobiliary division

Compensatory - segments can be removed with no real loss to the liver - other segments can take over

96
Q

Which lobe is the bare area of the liver found in?

A

Right lobe

97
Q

Where are the coronary and triangular ligaments found?

A

Coronary ligament - the superior edge of the free border of the liver

Triangular ligaments x2 - pointy bits of the edge of the free border of the liver

98
Q

Describe the blood supply to the liver

A

70% from the portal vein

30% from hepatic artery (coeliac trunk)
Hepatic artery runs in the free edge of the lesser omentum

99
Q

Where does the gallbladder get its blood supply?

A

Cystic artery

—> hepatic

—> common hepatic

—–> coeliac trunk

100
Q

What is the Pringle Manoeuvre?

A

Pinching the free edge of the lesser omentum to cut off the blood supply to the live

101
Q

What structures can be found in the free edge of the lesser omentum?

A

Common bile duct

Heptic artery

Portal vein

102
Q

What organs are drained by the portal vein?

A

Spleen

Majority of GI tract

103
Q

Why does the spleen sometimes get enlarged in liver disease?

A

Liver disease can increase the backwards pressure from the portal vein

Puts back-pressure on the splenic vein, enlarging the spleen

104
Q

What is the name given to the joining of portal and systemic venous systems?

Which 3 places can they be found?

A

Port-systemic anastomoses

Inferior oesophagus

Umbilicus

Rectum

105
Q

Which way does blood shunt if a patient has for example fibrotic liver disease?

A

Blood shunts from portal venous system to system venous system, causing varices

106
Q

Where does the gallbladder drain into?

A

Major duodenal papilla at the 2nd part of the duodenum

107
Q

Which 2 structures form the bile duct?

A

Cystic duct

Common hepatic duct

108
Q

Where is the surface anatomy marking for the gallbladder?

A

Tip of the right 9th costal cartilage - transpyloric place

109
Q

What is Murphy’s sign?

A

During abdo exam - ask patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line.

Make patient breathe in to move abdo contents downwards by the diaphragm.

If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner’s fingers) and winces with a “catch” in breath, the test is considered positive.

110
Q

Name the space between the liver and the kidney.

Why is this important?

A

Hepato-renal (Morison’s) pouch

When a patient lies on their back it can spread infection from the abdomen and cause abscesses

111
Q

Where is the subphrenic space?

A

Superior to the liver, between the liver and the diaphragm

112
Q

Where can gallbladder pain refer to?

A

R hypochondrium

R shoulder (C3-5)

Epigastrum

113
Q

What is the surface marking for the pancreatic neck?

A

Transpyloric plane (L1)

114
Q

What sits near the splenic hilum?

A

Pancreatic tail

115
Q

What is the hepato-pancreatic sphincter?

A

Guards the entrance of the duct of the duodenum

116
Q

What is the hepato-pancreatic sphincter?

Why is this site important?

A

Guards the entrance of the duct of the duodenum

Forms the boundary between foregut and midgut

117
Q

What 2 structures in utero form the pancreas?

Which parts of the pancreas do they form?

Where are they joined to?

A

Ventral pancreatic bud

  • head, thick bit of pancreas
  • common bile duct —> major duodenal papilla

Dorsal pancreatic bud

  • tail of pancreas
  • minor duodenal papilla
118
Q

What happens to form an anular pancreas?

A

Ventral bud of the pancreas does not swing back behind the duodenum, but wraps around it causing an obstruction

119
Q

In which peritoneal cavity region can fluid associated with pancreatitis accumulate?

A

Lesser peritoneal sac

120
Q

Where does the pancreas and duodenum get its arterial supply from?

A

Superior pancreaticoduodenal artery - coeliac trunk

Inferior pancreaticoduodenal artery - SMA

121
Q

Where does the superior pancreaticoduodenal artery come from?

A

Coeliac trunk

122
Q

Where does the inferior pancreaticoduodenal artery come from?

A

SMA

123
Q

Describe the lymph drainage of the pancreas and duodenum

A

Coeliac nodes - thoracic duct - supraclavicular nodes

124
Q

What is the surface anatomy marking of the spleen?

A

Left posterior lateral abdominal wall

Ribs 9-11 or 10-12

125
Q

What is the spleen’s origin?

A

Mesenchymal origin

126
Q

Which organs contact the spleen?

A

Stomach

Pancreas

L kidney

Splenic flecture of the colon

127
Q

Describe the venous and lymph drainage of the spleen

A

Splenic vein - contributes to portal vein

Lymph drainage to coeliac nodes

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