What nerve supplies SNS innervation to the foregut?
Greater splanchnic nerves (T5 to T9)
What nerves supplies PNS innervation to the foregut?
Vagus
What nerve supplies SNS innervation to the midgut?
Lesser splanchnic (T9 to T11)
What nerve supplies PNS innervation to the midgut?
Vagus
What nerve supplies SNS innervation to the hindgut?
Lumbar splanchnic (T12-L2)
What nerve supplies PNS innervation to the hindgut?
Pelvic splanchnic (S2-S4)
What hiatus’ are found in the diaphragm?
T8- Inferior Vena Cava
T10- Oesophagus and vagus nerve
T12- Abdominal aorta and azygous/ hemiazygous vein, thoracic duct
Name 3 distinguishing characteristics of a lumbar vertebrae?
Fat bodies
Big quadrangular spinous process (point straight)
Triangle foreamen
What are the right and left crura of the diaphragm?
Crus
From inf diagram to vertebral bodies
Meet in the midline to form the median arcurate ligament which surrounds the aorta
What is the name of the triangle of smooth muscle in the bladder, what are its corners?
Trigone
Urethra and L/R ureters entering at an oblique
In the pelvic the ureters are crossed by what? (In M and F)
M: Ductus deferens
F: Uterine artery
What key ligament anchors the bladder, where does it attach?
Median umbilical ligament
From apex of bladder to umbilicus
The base (fundus) of the bladder is what shape and points in what direction?
Inverted triangle
Base points posterioinferiorly
What tissue surrounds the bladder?
Endopelvic fascia (loose fatty areolar tissue)
What is the most inferior part of the bladder and how is it secured?
Neck (most fixed part of bladder)- When bladder fills it enlarges upwards
In M: Puboprostatic ligament
In F: Pubovesical ligament
What is the most inferior part of the bladder and how is it secured?
Neck (most fixed part of bladder)- When bladder fills it enlarges upwards
In M: Puboprostatic ligament (Paired fibromuscular band)
In F: Pubovesical ligament (Paired fibromuscular band)
What is the name of the muscle in the bladder and what type of muscle is it? What feature allows it to stretch?
Detrusor muscle Smooth muscle (PNS makes it contract, SNS= relax) Contains rugae so it can distend without rise in internal pressure
What type of epithelium lines the bladder?
Transitional epithelium
Changes between columnar and squamous
What artery/ veins supplies the bladder?
Sup vesicle art/vein and inf vesicle art/vein (M)/Vaginal art/vein (F)
From internal iliac artery
What supplies PNS to the bladder?
Pelvic splanchnic nerves (S2-S4)
What supplies SNS to the bladder?
Hypogastric nerve (T12-L2) = Relaxation (urinary retention)
What supplies somatic innervation to the bladder?
Pudendal nerve (S2-S4)
What are the 5 layers of the bladder wall?
Mucosa Submucosa Inner longitudinal muscle layer Circular muscle layer Outer longitudinal muscle layer
What forms the IUS in females?
The 3 layers of the detrusor muscle
What two glands surround the external urethral orifice in females?
Skene’s muscus glands
What does the urethra pass through in the pelvic floor?
Urogential diaphragm
What makes the trigone different to the rest of the bladder?
No rugae
At what level does the ureter cross the pelvic brim?
Where the common iliac bifurcates
L5/S1
What vessel does blood supply to the foregut?
Coeliac trunk
What vessel does blood supply to the midgut?
Superior mesenteric artery
What vessel does blood supply to the hindgut?
Inferior mesenteric artery
What vessel does blood supply to the hindgut?
Inferior mesenteric artery
The greater splanchinc nerve comes from which levels and leads to which ganglion? What does it supply?
T5-T9
Coeliac ganglion
Stomach/ liver/ pancreas/ suprarenal glands/ bile duct
The lesser splanchnic nerve comes from which levels, leads to which ganglion and supplies what?
T10-T11
Aortico-renal ganlion
(Does kindeys and ureters)
The least splanchnic nerve comes from which levels, leads to which ganglion and supplies what?
T12
Superior mesenteric ganglion (joined by lesser splanchnic also)
ALL MIDGUT
The lumbar splanchnic nerve comes from which levels, leads to which ganglion and supplies what?
L1-L3
Inferior mesenteric ganglion
Colon
The hypogastric nerve comes from which levels, leads to which ganglion and supplies what?
L4-L5
Hypogastric ganglion
Rectum, bladder, prostate
The sacral nerves come from which nerve roots? What purpose do they serve?
S1-S4
Also supply rectum, bladder and prostate
How do hypogastric and sacral nerves join?
Sacral plexus meets nerves from the POST GANGLIONIC hypogastric nerves
(Supplies bladder, prostate and rectum)
The sympathetic chain and its splanchnic nerve branches contain which of the below?
Afferent fibres —- Efferent fibres — Both — None
Both
The inferior thyroid artery comes from where?
Subclavian - Thyrocervical trunk - Inf thyroid
The superior thyroid artery is a branch of…?
The external carotid artery
The ureter begins its descent to the bladder by running along the medial aspect of which muscle?
Psoas Major
The longitudinal muscle layer of the large intestine forms three distinct muscle bands. What are these bands of muscle called?
Teniae Coli
Which blood vessels supply the liver with blood?
Hepatic artery and hepatic portal vein
What is the main type of cell in the liver?
Hepatocyte
From which spinal segments do the parasympathetic nerves that supply the anal and urethral sphincters arise?
S2/S3/S4
Which nerve supplies taste to the posterior 1/3 of the tongue?
Glossopharyngeal
What are the attachements of the greater omentum?
Greater curve of stomach
Transverse colon
What are the three main divisions of the coeliac artery?
Left gastric
Common hepatic
Splenic
What is the name for the smooth muscle in the bladder wall?
Detrusor
At which vertebral level does the oesophagus begin?
C5/C6
What are the 4 layers of the adrenal glands and what does each layer produce?
Zona glomerulosa- Aldosterone
Zona Fasiculata- Cortisol
Zona Reticularis- Sex steroids (DHEA/ androstenedione)
Medulla- Noradrenaline/ adrenaline (Symp stimulation)
Where would you find the transpyloric plane?
Hand breath under xipisternum
Above subcostal plane
What are the names of the 4 planes use to create the 9 regions of the abdomen?
Subcostal plane
Transtubercular plane
R midclavicular plane
L midclavicular plane
What is the roof of the abdominal cavity?
Diaphragm
What are langers lines?
Cleavage lines in the skin show the orientation of collagen fibres in the dermis
Surgically always cut parallell to lines
Which direction to langers lines run in the abdomen?
Horizontally
What are the layers (running superficial to deep) of the anterior abdominal wall?
Skin- Epidermis and dermis (with BV's/ nerves) Superficial fascia- Campers/ Scarpa's Deep fascia- thin connective tissue Flat muscles x3 Vertical muscles x2
What are the two layers of the superficial fascia of the ant abdominal wall?
(Skin)
CAMPER’S - Outer fat
SCARPA’S- Inner membranous layer (lower 1/3 only)
(Deep fascia)
What are the three flat muscles of the ant abdominal wall?
External oblique (fibres infromedial) Internal oblique (fibres superiomedial) Transversus abdominis (transverse fibres) All aponeourose in midline to form LINEA ALBA
What is the linea alba?
An aponeurosis in the midline of the ant abdo wall, formed by the interwoven fibres of the three flat muscles
What are the two vertical muscles of the ant abdo wall?
Rectus abdominis (forms '6 pack') Pyramidalis (triangle, superficial to RA, base attaches to pubis)
What is the rectus sheath?
Formed by apenurosis of the three flat muscles, it encloses rectus abdominis and pyramidalis
What makes up the ant and post walls of the rectus sheath above the costal margin?
Ant: External oblique only
Post; Ribcage
What makes up the ant and post walls of the rectus sheath between costal margin and ASIS?
Ant: External and half internal oblique
Post : Half internal oblique and transversus abdominis
What makes up the ant and post walls of the rectus sheath below the ASIS?
All three (external/ internal oblique and transversus abdominis) move to anterior wall NO POST WALL
Which arteries and veins supply the ant abdominal wall?
Sup epigastric art/ vein
Inf epigastric art/ vein
What innervates the anterior abdominal wall?
Thoraco-abdominal nerves
From ant of 7-11th intercostal nerves
What are the two layers of the peritoneum and what are they made of?
Visceral and parietal
Made of simple squamous epithelium
(KNOWN AS MESOTHELIUM)
What is the term for increased volume of perioneal fluid?
Acscities
What is the lesser sac of the abdomen?
The omental bursa Lesser omentum (less curve stomach - liver) Greater omentum (greater curve of stomach and then over intestines)
What is the greater sac of the periotenum?
The general cavity of the abdomen
What is the role of the epiploic foreamen?
Connects greater and lesser sacs of the abdomen
What is the mesentary?
A fold of peritoneum on the post abdo wall which attaches organs to the abdo wall
What is an intraperitoneal organ?
9 examples
Completely covered in visceral peritoneum
Stomach, liver, spleen, first 5cm duodenum, jejunum, cecum, appendix, transverse and sigmoid colons
What is a retroperiotneal organ?
10 examples
Only have peritoneum anteriorly
(2nd part duodenum, ascending and descending colon, pancreas (except tail), kidneys, adrenals, uterus, IVC, aorta, oesophagus)
What vein drains the foregut?
Hepatic portal vein
What vein drains the midgut?
Hepatic portal vein
What vein drains the hindgut?
Heaptic portal vein
What are the start and end points of the foregut?
Mouth to duodenum major papillae
What are the start and end points of the midgut?
Duodenal major papillae to 2/3 along transverse colon
What are the start and end points of the hindgut?
Distal 1/3 transverse colon to rectum
What is an enema?
Fluid injection into the colon via the rectum
At what level does the abdominal aorta split into the common iliac’s?
L4
At what level does the IVC form?
L5
The left and right Kidneys lie between which vertebral levels?
Left: T11-L2
Right: T12-L3
Free fluid in the abdomen must come from which type of organ?
Intraperitoneal
What is an alternative name for, and where is the pouch of douglas?
Recto-uterine pouch
(Between uterus and rectum)
Extension of peritoneum
How does the appendix recieve blood supply?
From the appendicular artery
- Travels down appendix
- So if inflammation then the artery is occluded and the tissue becomes necrosed
What are the first and second most common positions to find the appendix in?
1) Retrocecal
2) Pelvic