Abdominal Wall And Peritoneum Flashcards Preview

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Flashcards in Abdominal Wall And Peritoneum Deck (135):
1

The pelvic inlet is formed from

- Pectin pubis (pubic bone)
- Arcuate line (ilium)
- Sacral promontory (sacrum)

2

Continuous with the superficial fatty layers in the thorax, thick and perineum

Fatty layer (Camper's fascia)

3

Continuous with the fascia Lata in the thigh and with the deep layer of superficial perineal fascia

Scarpa's fascia (membranous layer)

4

The membranous layer (scarpa fascia) is just deep to what

Fatty layer (Camper Fascia)

5

Superficial blood vessels run in the ____ layer of superficial fascia

Fatty layer (Camper fascia)

6

The membranous (Scarpa's fascia) fuses with the ______ and is continuous over the ___ and __-

Fascia Lata, and is continuous over the pets and scrotum

7

Does the deep fascia of the abdominal wall follow the same pattern as the membranous layer of superficial fascia

No

8

There is a potential space between the the membranous layer of superficial fascia (Scarpa fascia) and the ______ of the external abdominal oblique muscle

Deep fascia ( note that fluid can leak into this potential space between the membranous layer of superficial fascia and the deep fascia of the external abdominal oblique muscle)

9

Abdominal midline

Linda Alba

10

Lateral border of rectus abdominus muscle

Linea semilunar is (semilunar line)

11

Transverse plane midway between the superior borders of the pubic symphysis and the manubrium

Transpyloric plane

12

Plane at the lowest level of the costal margin (the inferior margin of the tenth costal cartilage)

Subcostal plane

13

Plane passing through the summits of the iliac crests

Supracrestal plane

14

Plane at the level of the iliac tubercles (the iliac tubercle lies-5cm posterolateral to the nation superior iliac spine)

Transtubercular plane

15

Plane at the level of the anterior superior iliac spine

Interspinous plane

16

Contents of the RUQ (most superficial to deepest)

Liver, Gallbladder, Suprarenal glands and kidneys

17

Contents of the LUQ most superficial to deepest

Stomach and transverse colon, then Spleen, pancreas, and duodenum, Then kidneys, Suprarenal glands, and the abdominal aorta (this is slightly left of midline

18

The ascending colony with cecum and vermiform appendix is in what quadrant

RLQ

19

The descending colon is in what quadrant

LLQ

20

____ pairs of muscles, located anteriorly and laterally collectively compress and hold the abdominal organs in place. What are they.

- 4
- External obliques
- Internal obliques
- Transversus abdominis
- rectus abdominis

- note that these work together to flex and stabilize the vertebral column
- When they unilaterally contract they laterally flex the vertebral column

21

_____ pairs located in the posterior abdominal wall flex the spin and lower limb. What are they

- Iliacus
- Psoas major
- Psoas minor
- Quadratus lumborum

22

The three "flat" muscles of the anterior/lateral abdominal wall end anteriorly in a strong sheet of aponeurosis called the _____-

Rectus sheath

23

The rectus sheath encloses the _____-

Rectus abdominis

24

The midline of the rectus sheath is the ____

Linea Alba

25

Are the layers of fascia and aponeurosis of the muscles forming the rectus sheath are arranged differently in the upper abdominal wall than they are in the lower wall

Yes

26

The ___ is the line where the layers of fascia and aponeurosis of the muscles forming the rectus sheath are arranged differently in the upper and lower abdominal wall

Arcuate line

27

The Arcuate line is located

About half way between the umbilicus and pubic symphysis

28

Above the Arcuate line, the aponeurosis from the _______ splits to surround ______ and the aponeurosis from the __________ runs posterior to ________

Above the Arcuate line, the aponeurosis from the internal oblique splits to surround rectus abdominis and the aponeurosis from Transversus abdominus runs posterior to rectus abdominis

29

Below the Arcuate line, the rectus abdominis muscle lies

Directly on transversal is fascia

30

What muscle has fibers that project inferomedially to form the inguinal ligament

External oblique

31

Bony landmarks of anterior abdominal wall

- Xiphoid process
- Costal margins
- Ilium
- Pubis

32

Muscles of the posterior abdominal wall

Iliacus, Psoas major, Psoas minor, Quadratus lumborum

33

Superficial arteries of Abdominal Wall

- Superficial circumflex iliac artery
- superficial epigastric artery
- external pudendal artery (superficial branch, and deep branch)

34

The deep drainage of the anterior abdominal wall veins go to the

Subclavian vein, eternal iliac vein, lumbar, and intercostal veins

35

Anterior abdominal wall veins are within the ____ fascia and are what veins

Campers fascia, thoracoepigastric veins, lateral thoracic veins, and superficial epigastric veins

36

What are the dermatomes. Of the anterior abdominal wall

T7-L1

37

What dermatomes is at the Xiphoid region (tip)

T7

38

What is the dermatomes at the umbilical region

T10

39

What is the dermatomes at the inguinal fold

L1

40

What are the nerves of the anterior abdominal wall

- sensory : Dermatomes (T7-L1)
- Innervated muscles (motor): Intercostal nerves (T7-T11), sub costal nerve (T12) , Lumbar nerve (L1-L4)

41

The cutaneous branches of ventral rami, intercostal nerves (T7-T11) of the anterior abdominal wall lie between _____ and ______. They pierce the _____ to innervate the rectus abdominis muscles. They supply ____. ____ and ______. and are angled _____

The cutaneous branches of ventral rami, intercostal nerves (T7-T11) of the anterior abdominal wall lie between internal abdominal oblique and transverse abdominis. They Pierce the rectus sheath to innervate the rectus abdomens muscles. They supply skin, muscles and parietal peritoneum. They are angled inferiomedially

42

The ilioinguinal nerve (L1) enter the ____ canal and merges through the ____. Supplies ___ and ____

enters the inguinal canal and emerges through the superficial inguinal ring. Supplies groin and scrotum/labium majus

43

Iliohypogastic nerve arises form the ventral rami of Nerve ____ and branches into the ____ and ____ which supplies ______ region

L1 (sometimes plus T12), lateral cutaneous branch and anterior cutaneous branch, supra pubic region

44

The genitofemoral nerve is a branch of ___ and ___

L1 and L2

45

The genital branch of genitofemoral nerve exits the ____ and innervates the

exits the inguinal canal through the superficial inguinal ring. Innervates the cremaster muscle or is cutaneous to the labium majus

46

The femoral branches of the genitofemoral nerve (L1, L2) is cutaneous to the

femoral triangle area

47

Superficial lymphatic drainage of the anterior abdomen drains superiorly from ____ to _____ and drains inferiorly form _____ to ___

- Drains superiorly from umbilical region to anterior axillary and sternal nodes
- inferiorly from umbilical region to superficial inguinal nodes

48

Deep lymphatic drainage of anterior abdomen

- along posterior intercostal and lumbar vessels to deep abdominal nodes
- from testes to deep abdominal nodes

49

Portion of the viscera protrudes through a weakened point of the muscular wall of the abdominal cavity

hernia

50

What is a strangulated intestinal hernia

When herniated portion of the intestine swells thus becoming trapped and the blood flow to the trapped segment diminishes causing that portion of the intestine to die

51

What are the two types of hernias

- Inguinal hernias
- Femoral hernias

52

An _____ hernia is the most common type of hernia to require treatment

Inguinal hernia

53

The inguinal region is one of the ____ areas of the abdominal wall

weakest

54

Are males more likely to develop inguinal hernias than females

yes

55

What causes an inguinal hernia

Rising pressure in the abdominal cavity provides the force to push a segment of the small intestine into the canal

56

what are the two types of inguinal hernias

- Direct inguinal hernia
- indirect inguinal hernia

57

What is a direct inguinal hernia

the loop of small intestine protrudes directly through the superficial inguinal ring, but not down the entire length of the inguinal canal, and creates a bulge in the lower anterior abdominal wall

58

what is an indirect inguinal hernia

herniation travels down the entire inguinal canal and may even extend all the way into the scrotum

59

Indirect inguinal hernias are more common in

younger males and may be congenital

60

indirect inguinal hernias pass _____ to epigastric vessels to _____ to enter _____ and follows the path of

lateral to inferior epigastric vessels to enter deep inguinal ring, follows path of spermatic cord

61

What type of hernia is usually acquired an happens in females as well

Direct inguinal hernias

62

In direct inguinal hernias herniation passes ___ to inferior epigastic vessels punching though ___ and ____

medial to inferior epigastric vessels punching through peritoneum and transversalis fascia

63

Femoral hernia occurs in the _____

upper thigh, just inferior to he inguinal ligmanet, originating in the femoral triangle

64

The ___ part of the femoral triangle is relatively weak and prone to stress injury, allowing a loop of small intestine to protrude

medial

65

Women more commonly develop femoral hernias because of the

greater width of their femoral triangle

66

_____occur when a portion of intestine pushes through abdominal wall musculature in the periumbilical or umbilical region

umbilical hernia

67

Umbilical hernias are most common in ___ but can occur in ___ as well

infant, adults

68

Derivatives of foregut (celiac trunk)

- Esophagus, stomach, duodenum, liver, gallbladder, spleen, and pancreas

69

Derivatives of midgut (superior mesenteric artery)

Duodenum, jejunum, ileum, cecum and appendix, ascending colon, 2/3 of transverse colon

70

Derivatives of hindgut (inferior mesenteric artery)

1/3 transverse, descending and sigmoid colon, rectum and anal canal

71

serous membrane of the abdomen

peritoneum

72

What are the subdivisions of the peritoneum

- Parietal layer (lines the body wall)
- Viscer alyer (serosa)- covers viscera

73

Which of the peritoneum layers has abundant pain fibers

Parietal layer has abundant pain fibers via nerves form the body wall. The visceral layer lacks pain fibers

74

These organs have a mesentery and are completely covered by the peritoneum

Intraperitoneal organs

75

what are the abdominal cavity intraperitoneal organs

- Stomach
- Small intestine (jejunum, ileum, some of the superior part of the duodenum)
- Spleen
- Liver
- Gallbladder
- Cecum with vermiform appendix (portions of variable size may be retroperitoneal)
- Large intestine (transverse and sigmoid colons)

76

What are the pelvic cavity intraperitoneal organs

- Uterus (fundus and body)
- Ovaries
- Uterine tubes

77

These organs either have no mesentery or lost it during development

Extraperitoneal organs

78

Primarily retroperitoneal organs

- kidneys
- suprarenal glands
- Uterine cervix
- ureters
- adrenals
- gonads
- aorta and inferior vena cava

79

Secondarily retroperitoneal organs (became retroperitoneal during development)

- duodenum (descending, horizontal, and ascending)
- ascending and descending colon
- pancreas
- rectum (upper 2/3)

80

What are the infra peritoneal/subperitoneal organs

- urinary bladder
- distal ureters
- prostate
- Seminal vesicle
- uterine cervix
- Vagina
- Rectum (lower 1/3)

81

Intraperitoneal organs are covered on most sides by ______ and suspended by ____ form the body wall

visceral peritoneum, suspended by mesentery from the body wall

82

Retroperitoneal organs lie deep to the _____ and are covered by ___ on one side only

parietal peritoneum, parietal peritoneum

83

what part(s) of the small intestine are retroperitoneal

- duodenum (descending, horizontal, and ascending) note that the jejunum, ileum, and superior part of the duodenum are intraperitoneal organs

84

2-layered fold of peritoneum

the mesenteries

85

"The mesentery" attaches _____ to the posterior body wall

free small intestine (jejunum and ileum)

86

Transverse mesocolon

- mesentery of the transverse colon
- holds the transverse colon to the posterior body wall
- fuses with the posterior layer of the greater omentum

87

The transverse mesocolon fuses with the posterior layer of the ______

greater omentum

88

Sigmoid mesocolon

- mesentery of the sigmoid colon
- holds the sigmoid colon to the posterior body wall

89

Mesoappendix

Mesentery of the vermiform appendix

90

The mesenteries of the duodenum, ascending colon, descending colon and cecum are usually lost during development. Since they are no longer suspended by a mesentery, these organs are _____

secondarily retroperitoneal

91

peritoneal ligaments may be subdivisions of a ____ structure

larger

92

Peritoneal ligament usually transmit ___ and ____

nerves and vessels

93

Peritoneal ligaments usually lack ____ and are not the same as ligaments that join bones

Connective tissue

94

Examples of peritoneal ligaments

Gastrosplenic ligament, splenorenal (lienorenal) ligament

95

Broad, 2-4 layered sheet of peritoneum that attaches the stomach to other viscera

Omentum (epiploon)

96

The lesser omentum develops from the ________

Ventral mesogastrium (mesentery)

97

The lesser omentum is subdivided into two parts

- hepatogastric ligament (stomach to liver)
- Hepatoduodenal ligament (liver to duodenum)

98

Peritoneal reflections (adult)

- Greater Omentum
- Gastrocolic ligament
- Gastrophrenic ligament
- Gastrosplenic ligament

99

The greater omentum develops form the

dorsal mesogastrium

100

The Gastrocolic ligament attaches the

stomach to transverse colon

101

The Gastrophrenic ligament attaches the

stomach to diaphragm (is continous with phrenicosplenic ligament)

102

The Gastrosplenic ligament attaches the

stomach to the spleen

103

What are the peritoneal ligaments that are associated with the liver

- Coronary ligaments
- Right and left triangular ligaments
- Falciform ligaments
- Ligamentum teres hepatis

104

a ridge or elevation in the peritoneum produced by underlying vessels

Folds

105

The fossae (fossa) or recesses are

depressions between folds

106

Examples of abdominal fossa or recesses

- superior duodenal fold and fossa (recess)
- Paraduodenal fossa
- inferior deuodenal fold and fossa
- retroduodenal fossa
- Fold is formed by inferior mesenteric vein posterior to peritoneum

107

Structures coursing through the exztraperitoneal tissue form elevations on the interior abdominal wall called _____

peritoneal (umbilical) folds

108

Median umbilical fold

- Urachus
- midline from bladder

109

Medial umbilical folds

- 2
- medial umbilical ligaments
- obliterated umbilical aa.

110

Lateral umbilical fold

- 2
- inferior epigastric vessels
- Functional aa. and vv.

111

supraumnbilical structures located on the internal aspect of the anterior abdominal wall

- falciform ligament

112

Falciform ligament

- curved remnant of the ventral mesogastrium
- ligamentum teres hepatis (round ligament of the liver) in tis lower free border
- Obliterated umbilical vein

113

The Supravesical fossa is between the ___ and ____ umbilical folds

median and medial

114

The supravesical fossa is the site for ______

supravesical hernias (rare)

115

The medial inguinal fossa is between the ____ and _______

medial and lateral umbilical folds

116

The medial inguinal fossa is the site for

direct inguinal hernias

117

The medial inguinal fossa is also called the

inguinal triangle

118

The lateral inguinal fossa is lateral to the

lateral umbilical folds

119

The lateral inguinal fossa is the site for

indirect inguinal hernias

120

The _____ is most of the potential space within the abdomen

Greater sac

121

The greater sac can be subdivided into

supracolic an infracolic regions by the colon and transverse mesocolon

122

The supramesocolic (supracolic) region of the greater sac is superior and anterior to the ___ and the ___ and includes

liver and the stomach and includes hepatorenal and subphrenic spaces and fossa of the anterior wall

123

The peritoneal cavity is a ____ potential space between parietal and visceral layers of peritoneum

closed

124

recesses and fossa of the peritoneal cavity

- Subphrenic recess
- subhepatic/hepatorenal recess
- rectovesical/rectouterine recess

125

Why are the recesses and fossa of the peritoneal cavity of clinical importance

Because abscesses may develop and excess fluid (ascites) will pool here

126

inferior and posterior part of the greater sac

- Inframesocolic (infracolic) region of the greater sac of the peritoneal cavity

127

The inframesocolic region of the greater sac is subdivided by

mesenteries and ligaments

128

the upper and lower parts of the inframesocloic (infra colic) region of the greater sac is divided by _______ into right and left infra colic spaces

The mesentery

129

What limits the spread of fluid superiorly in the inframesocolic region

phrenicocolic ligament

130

The lesser sac (omental bursa) develops as a part of the

greater sac

131

The lesser sac is _____ and ____ to the stomach

posterior and inferior

132

Greater and lesser peritoneal sacs communicate through the

Epiploic foramen (of Winslow)

133

Recesses of the lesser sac

- Superior recess (posterior to the liver)
- Inferior process (potential space between the 2 layers of the gastrocolic ligament)
- Splenic recess (posterior to and left of the stomach)

134

The lesser sac has a clinically important relationship to the

liver, pancreas, stomach, and spleen.

135

Epiploic forament (of Winslow) (omental foramen)

- opening between the greater and lesser sacs
- anterior: hepatoduodenal ligament with the portal vein, hepatic artery and bile duct
- posterior: IVC, diaphragm
- Superior: liver, caudate lobe
- Inferior: duodenum, 1st part