Anatomy Flashcards
(188 cards)
1
Q
trans umbilical plane
A
passes through umbilicus at intervertebral disk between L3 and L4
2
Q
RUQ contents
A
right lobe of liver gallbladder stomach: pylorus duodenum: parts 1-3 pancreas: head right suprarenal gland right kidney right colic (hepatic) flexure ascending colon: superior part transverse colon: right half
3
Q
LUQ contents
A
left lobe of liver spleen stomach jejunum and proximal ileum pancreas: body and tail left kidney left suprarenal gland left colic (splenic) flexure transverse colon: left half descending colon: superior part
4
Q
RLQ content
A
cecum vermiform appendix most of ileum ascending colon: inferior part right ovary right uterine tube right ureter: abdominal part right spermatic cord: ab part uterus urinary bladder if full
5
Q
LLQ content
A
sigmoid colon descending colon: inferior part left ovary left uterine tube left ureter: ab part left spermatic cord: ab part uterus urinary bladder if full
6
Q
RUQ abdominal pain ddx
A
dissecting aneurysm gallbladder disease hepatitis hepatomegaly pancreatitis peptic ulcer disease pyelonephritis kidney stones renal infarct appendicitis
7
Q
LUQ abdominal pain ddx
A
dissecting aneurysm esophagitis hiatal hernia esophageal rupture gastritis pancreatitis peptic ulcer disease pyelonephritis kidney stones renal infarct splenic abscess splenic rupture splenic infarction
8
Q
RLQ pain ddx
A
appendicitis
cholecystitis
crohns
kidney stones
9
Q
LLQ pain ddx
A
diverticulitis IBS lactose intolerance celiac kidney stones constipation crohns ulcerative colitis intestinal obstruction
10
Q
lower abdomen pain ddx
A
aortic aneurysm colitis including IBS diverticulitis intestinal obstruction perforated viscus
11
Q
epigastric region
A
foregut organs
above L1
12
Q
paraumbilical region
A
midgut organs
L1-umbilicus
13
Q
suprapubic region
A
hindgut organs
below umbilicus
14
Q
how many layers are in the anterior abdominal wall
A
7-9 layers
15
Q
list layers of anterior abdominal wall from outside to inside
A
skin superficial fascia (Campers in superior region, Campers and Scarpa in inferior) deep fascia (epimysium) muscle (0,1, or 3) transversalis fascia extraperitoneal fat parietal peritoneum
16
Q
where is scarpas fascia located
A
only below umbilicus
superiorly attaches to rectus / external oblique epimysium
may retain fluid underneath due to straddle injury
17
Q
what is diastasis recti
A
abdominal separation
gap of roughly 2.7 cm or greater between the sides of the rectus abdominus muscle
18
Q
who gets diastasis recti
A
newborns and pregnant women
19
Q
4 variations of diastasis recti
A
open (split vertically)
open below navel
open above navel
completely open (split vertically and horizontally)
20
Q
how many layers are in the wall of the linea alba
A
6 skin superficial (Camper) fascia linea alba transversalis fascia extraperitoneal fat parietal peritoneum
21
Q
how many layers are in the wall of the rectus abdominis above the umbilicus
A
8 skin superficial (Camper) fascia anterior rectus sheath rectus abdominis muscle posterior rectus sheath transversalis fascia extraperitoneal fat parietal peritoneum
22
Q
how many layers are in the wall of the rectus abdominis below the umbilicus
A
7 skin superficial fascia (Camper and Scarpa) anterior rectus sheath rectus abdominis muscle transversalis fascia extraperitoneal fat parietal peritoneum
23
Q
how many layers are in the wall lateral to the rectus abdominis
A
8 skin superficial (Camper) fascia external oblique muscle internal oblique muscle transversus abdominis muscle transversalis fascia extraperitoneal fat parietal paeritoneum
24
Q
where is the inguinal canal
A
above inguinal ligament
formed by descending of testis or round ligament of uterus
25
describe the movement of the testis
was located inside abdominal cavity between parietal peritoneum and transversalis fascia
retroperitoneal
transversed obliquely during embryogenesis through the layers of anterolateral abdominal wall just above inguinal ligament
26
contents of male inguinal canal
spermatic cord- ductus deferens, testicular artery and vein
| go into scrotum
27
contents of female inguinal canal
round ligament of uterus
| attaches to subcutaneous tissue of labium majus
28
what is an abdominal hernia
protrusion of parietal peritoneum and/or abdominal viscera (small intestine) through a normal or abnormal opening from the cavity
29
what % of abdominal hernias are inguinal
80-90%
30
what determines if emergency treatment is required for a hernia
if it is strangulated
31
direct (acquired) inguinal hernia
herniating bowel passes medial to inferior epigastric vessels
pushes through peritoneum and transversalis fascia in inguinal triangle
enters inguinal canal
32
indirect inguinal hernia
herniating bowel passes lateral to inferior epigastric vessels to enter deep inguinal ring
33
predisposing factor for direct inguinal hernia
weakness of anterior abdominal wall in inguinal triangle
34
frequency of direct inguinal hernia
less common
1/3 to 1/4
older men
35
layers that exit from abdominal cavity in direct inguinal hernia
peritoneum plus transversalis fascia
36
course of direct inguinal hernia
through or around inguinal canal, usually transversing only medial third of canal, external and parallel to vestige of processus vaginalis
37
direct inguinal hernia exit from anterior abdominal wall
via superficial ring
lateral to cord
rarely enters scrotum
38
predisposing factor for indirect inguinal hernia
patency of processus vaginalis in younger persons
39
frequency of indirect inguinal hernia
2/3 to 3/4
| common in newborns
40
layers that exit from abdominal cavity in indirect inguinal hernia
peritoneum of persistent processus vaginalis plus all 3 fascial coverings of cord/round ligament
41
course of indirect inguinal hernia
transverses inguinal canal (entire canal if sufficient in size) within processus vaginalis
42
indirect inguinal hernia exit from anterior abdominal wall
via superficial ring inside cord
| commonly passes into scrotum/labium majus
43
umbilical abdominal hernia
around umbilicus
| common in newborns
44
epigastric abdominal hernia
midline along linea alba above umbilicus
45
semilunar abdominal hernia
along semilunar line
| where external transverse connect to rectus abdominis
46
diaphragmatic abdominal hernia
typically posterior and left sided
47
sex differences in groin hernias
men 8x more likely to get one and 20x more likely to need a repair
lifetime risk is 25% in men and 5% in women
women median age 60-79
men median age 50-69
48
what is the etiology of caput medusa
superficial veins anastomose with deep veins
| when deep veins are blocked superficial veins are enlarged
49
when do you see caput medusa
hepatic portal vein hypertension or obstruction
causes embryonic umbilical vein to reopen and carry blood away from the liver onto the anterior abdominal wall veins (superior and inferior epigastric veins)
50
why do you get hypothesia instead of anesthesia when a dermatome isn't working
segments overlap with one another
51
xiphoid process dermatome
T7
52
umbilicus dermatome
T10
53
inguinal ligament dermatome
L1
54
common abdominal surgical incisions
```
anterior subcostal
upper midline laparotomy (stomach, pancreas)
periumbilical midline laparotomy
pararectal incision (sigmoid colon)
lower midline laparotomy
mcburnery (appendix)
inguinal incision (inguinal canal)
pfannenstiel incision (pelvic organs)
```
55
what is the peritoneum
transparent serous membrane that lines the abdominopelvic cavity and wraps around the organs
56
2 peritoneum layers
parietal- lines internal surface of the walls of the cavity
| visceral- wraps around organs
57
parietal peritoneum pain sensation
served by same blood and lymphatic vessels and nerves in the region that it is adjacent to
sensitive to all general somatic sensations
pain well localized
58
visceral peritoneum pain sensation
served by the same blood and lymphatic vessels and nerves as the organ it covers
not sensitive to general sensations
sensitive to stretch and chemical irritation
pain poorly localized, may be referred to surface
59
cell type in the peritoneum
simple squamous epithelial cells
| mesothelium
60
intraperitoneal organs
completely covered by peritoneum and has a mesentary
61
retroperitoneal organs
partially covered by peritoneum
62
mesentary
2 layers of peritoneum adhere together connecting intraperitoneal organs to abdominal wall
63
why is the female peritoneum not closed
opens through uterine tubes, uterus, and vagina
64
greater omentum
starts from greater curvature of the stomach and proximal duodenum
drapes down like an apron and folds back upwards to attach to transverse colon
65
lesser omentum
connects lesser curvature of stomach and duodenum to liver
66
function of greater omentum
prevents visceral peritoneum adherence to parietal peritoneum
stores excess calories
cushions abdominal organs
insulates against heat loss
adheres to inflamed organs to localize infection
can herniate
67
what are peritoneal ligaments
double layer peritoneum that connects ne organ with another organ or to the peritoneal wall
68
peritoneal folds
reflection of peritoneum raised from the internal abdominal wall by underlying structures (usually blood vessels and ducts)
69
peritoneal lesser sac
space posterior to lesser omentum and stomach
70
peritoneal greater sac
main and larger part of peritoneal cavity
71
2 compartments of greater sac
supracolic
| infracolic
72
supracolic compartment of greater sac
above transverse colon, including stomach, liver and spleen
73
infracolic compartment of greater sac
below transverse colon, including small intestine, ascending and descending colon
74
typical peritoneal fluid volume
20 ml
| increases to 50 ml during ovulation
75
typical peritoneal fluid color
clear and/or slightly yellowish
76
cloudy, turbid peritoneal fluid
infection
77
milky peritoneal fluid
inflammatory condition
| peritonitis, pancreatitis, appendicitis
78
red peritoneal fluid
traumatic tap or malignancy
79
green peritoneal fluid
ruptured gall bladder, pancreatitis, or intestinal perf
80
what is peritonitis
infection and inflammation of peritoneum
81
etiology of peritonitis
traumatic penetration or rupture of abdominopelvic organs
gas, fecal matter, bacteria enters peritoneal cavity
exudation of serum, fibrin, cells, pus into cavity
82
symptoms of peritonitis
pain, fever, gas under diaphragm when standing, paralyzed bowel movement, ab wall guarding
83
what is ascites
excess fluid accumulation in peritoneal cavity
several liters of fluid
resp and bowel movements can be affected
84
etiology of ascites
internal bleeding, portal hypertension, cancer metastasis, starvation
85
starvation ascites in children
Kwashiorkor
severe malnutrition caused by deficiency in dietary protein
lack of protein causes osmotic imbalance in GI and causes swelling of the gut
86
abdominal paracentesis
surgical puncture of the peritoneal cavity for the aspiration and drainage of fluid
typically for diagnostics
therapeutic to reduce intra-abdominal pressure
87
intraperitoneal injection
peritoneum is semipermeable and lies over blood vessels and lymphatic ducts
fluid injected into peritoneal cavity is absorbed rapidly
some ovarian cancer treatments involve this type of admin
88
peritoneal dialysis
helps renal failure patients
89
what are peritoneal adhesions
healing from infection, inflamm, or surgery causes fibrous tissue to form between visceral peritoneum or between visceral and parietal peritoneum
90
result of peritoneal adhesions
limit normal movement of viscera causing ab pain, gut twisting, or volvulus
91
treatment for severe peritoneal adhesions
surgical separation of adhesions
92
overview of GI tract
mouth > pharynx > esophagus > stomach > small intestine (duodenum, jejunum, ileum) > large intestine (cecum, ascending, transverse, descending, sigmoid, rectum) > anal canal
93
organs associated with GI tract
liver, gallbladder, pancreas, spleen, kidneys, adrenals
94
what is the significance of the primitive GI tract separations
each region gives rise to organs that share the same primary blood supple, nerve innervation, and lymphatic drainage route
95
foregut organs
```
mouth
pharynx
esophagus
stomach
superior half of duodenum
```
96
midgut organs
```
inferior half of duodenum
jejunum
ileum
cecum
appendix
ascending colon
right 2/3 of transverse colon
```
97
hindgut organs
left 1/3 of transverse colon
descending colon
sigmoid colon
rectum
98
3 constrictions of esophagus
cervical- junction w pharynx
thoracic- crossing w aortic arch/ L main bronchus
diaphragmatic- junction with stomach
99
muscle makeup of esophagus
internal circular and external longitudinal muscles
superior 1/3 = voluntary striated
mid 1/3 = mix of smooth and striated
inferior 1/3 = all smooth muscle
100
another name for pyrosis
heartburn
101
etiology of pyrosis
regurgitation of small amounts of food or gastric fluid into lower esophagus
102
common perception of pyrosis
chest pain
103
describe the venous drainage of the lower esophagus
dual venous drainages- to systemic veins via azygous vein system and to the liver via portal vein
104
etiology of esophageal varices
during portal hypertension, most venous blood flows through lower esophageal region toward azygous veins causing varices
105
outcome of esophageal varices
can be ruptured by food resulting in extensive internal bleeding into stomach
may vomit fresh blood (not exposed to stomach acid)
106
what is Zenker diverticulum
a posterior evagination off the upper portion of the esophagus just below the lower pharynx
107
symptoms of zenker diverticulum
```
often asymptomatic
found in older adults
dysphasia/ lump in throat
food trapped in outpouching, leading to:
-regurgitation
-cough
-halitosis
-infection
```
108
stomach cardia
part surrounding the cardial orifice (connection w esophagus)
109
fundus of stomach
dilated superior part, reaches left 5th intercostal
110
body of stomach
major part between fundus and pyloric antrum
111
pyloric part of stomach
pyloric antrum
pyloric canal
pylorus (sphincter)
pyloric orifice
112
gastric rugae
gastric folds
| longitudinal ridges of gastric mucosa on the interior of the stomach
113
3 nonpaired arteries to the abdomen
1. celiac trunk/axis
2. superior mesenteric artery (SMA)
3. inferior mesenteric artery (IMA)
114
what arteries come off the celiac trunk to the stomach?
```
celiac trunk at T12
-left gastric (left lesser curvature)
splenic artery:
-left gastro-omental (left greater curvature)
-short gastric (fundus)
common hepatic artery:
-right gastric (right lesser curvature)
-right gastro-omental (right greater curvature)
```
115
where do veins of stomach drain to
hepatic portal vein
116
where do lymph nodes of stomach drain to
celiac lymph nodes
117
what is a hiatal hernia
protrusion of part of the stomach into the mediastinum through esophageal hiatus
118
two types of hiatal hernia
sliding (95%)
| paraesophageal (5%)
119
sliding hiatal hernia
abdominal portion of esophagus + cardia + part of fundus all herniated
regurg possible
120
paraesophageal hiatal hernia
cardia remains in normal position
part of fundus herniated
usually no regurg
121
congenital diaphragmatic hernia
1/2200 newborns
poor development of diaphragm
may have pulmonary hypoplasia
high mortality
122
incidence of hiatal hernias
increases w age
60% of people aged 50 or older
9% are symptomatic
123
symptoms of hiatal hernia
heartburn
difficulty swallowing
nausea, vomiting
usually worse after meals or when laying flat
124
pylorospasm
spasmodic contraction of pylorus
| food stays in stomach, resulting in overfilling and vomiting
125
congenital hypertrophic pyloric stenosis
1/150 males
| 1/750 femals
126
carcinoma of stomach
most common in body or pyloric part of stomach
| associated with feeling full and vomiting
127
gastric ulcer
an open lesion of stomach mucosa, associated with infections of H.pylori
ulcer erodes arteries, causes bleeding and can cause wall perforation
128
referred pain from stomach
epigastric region pain
afferent fibers from stomach and 1st part of duodenum, via splanchnic nerve, go to T7-T8 level
dermatome sensation from T7, T8
129
4 parts of duodenum
superior- L1
descending - L2
horizontal- L3
ascending- L3-L2
130
overview of duodenum
25 cm
retroperitoneal
C-shaped around head of pancreas
131
what is inside the lumen of the duodenum
plicae circularies
major duodenal papilla
minor duodenal papilla
132
what significant structure enters the posteromedial wall of the duodenum
```
hepatopancreatic ampulla (common bile duct + pancreatic duct coming together)
ampulla surrounded by the hepatopancreatic sphincter (smooth muscle)
```
133
what arteries supply the duodenum from the celiac trunk?
common hepatic > gastroduodenal, which branches into:
- supraduodental artery
- posterior superior pancreaticoduodenal
- anterior superior pancreaticoduodenal
134
what arteries supply the duodenum from the superior mesenteric artery?
- posterior inferior pancreaticoduodenal
| - anterior inferior pancreaticoduodenal
135
where do duodenal veins drain?
hepatic portal vein
136
what is a duodenal/peptic ulcer?
inflammatory erosion of duodenal mucosa
can cause inflammatory adhesion to surrounding organs
perforations cause peritonitis
137
where do peptic ulcers occur?
65% occur on the posterior wall of the 1st part within 3 cm of the pylorus
138
what is a significant symptom of peptic ulcers?
erosion to gastroduodenal artery causes severe bleeding into duodenum, retroperitoneum, or lesser sac of peritoneal cavity
139
referred pain of duodenum
lower epigastric region and occasionally umbilical
| if irritates the diaphragm, upper right shoulder
140
jejunum
2/5 small intestine
| mostly in LUQ or around umbilicus
141
ileum
3/5 small intestine
| mostly in RLG or inguinal region
142
what is the mesentery
fan shaped peritoneal fold that attaches jejunum and ileum to the posterior abdominal wall
143
what are 3 differentiating factors between jejunum and ileum
wall thickness
vascular supply pattern
plicae circulares
144
jejunum wall
thick and heavy
145
ileum wall
thin and light
146
jejunum vascular supply
long vasa recta with a few large loops
147
ileum vascular supply
short vasa recta with many short loops
148
jejunum circular folds (plicae circulares)
large, tall, closely packed
149
ileum circular folds (plicae circulares)
low and sparse, absent in distal parts
150
peyers patches in jejunum vs ileum
few in jejunum
| many in ileum
151
bloody supply to jejunum and ileum
superior mesenteric artery gives of to the left 15-18 branches of mesenteric arteries to both jejunum and ileum
SMV collects blood to hepatic portal vein
152
ileal (meckels) diverticulum
most common congenital anomaly of the gut due to a remnant vitelline duct
contains 2 ectopic tissues- stomach mucosa and pancreatic
on opposite side of the mesentery
153
ileal (meckels) diverticulum rule of 2s
2% of the population
2" long
2 ft from ileocecal junction
154
symptoms of ileal (meckels) diverticulum
bleeding (consider for lower GI bleeding in children < 2)
GI track obstruction
when inflamed, pain mimics appendicitis
155
ileus
small bowel motility disorders that mimic obstruction (no mechanical obstruction)
156
paralytic ileus
paralysis of small bowel movement mostly due to surgery
stagnations = no peristalsis
ab distention, nausea, malaise
can be from unknown causes such as systemic illnesses
157
intussesception
part of intestine has invaginated into another section
happens in kids under 5
result in obstruction
diagnose w ultrasound (bulls eye)
can cut off blood supply and cause tissue of wall to die
158
symptoms of intussesception
```
sudden pain that comes and goes every 20 min
vomiting
stool w blood and mucus
nausea
cramping pain
```
159
treatment of intussesception
barium or air enema
laparotomy
surgery
160
small intesting referred pain
T10 periumbilical
161
unique anatomical characteristics of large intestine (OETHS)
omental (epiploic) appendices - small fatty omentum like projections
taenia coli- 3 longitudinal muscle bands, not present in the appendix and rectum
haustra- saccular protrustion between transverse folds
semilunar folds- separate haustra on interior
162
cecum
blind pouch
RLQ
intraperitoneal, no mesentery
orifice for appendix
163
vermiform appendix
blind intestinal diverticulum off of cecum
6-10 cm long, contains lymphoid tissue
has its own mesentery
164
epidemiology of appendicitis
common in young people
300,000 cases/year
most common cause of acute ab pain requiring surgery
165
pain associated with appendicitis
vague pain around umbilicus (T10)
may transfer to RLQ with time to "mcburneys point" due to direct inflammation of parietal wall of the anterior wall peritoneum
166
rupture of appendix
peritonitis
ab rigidity
nausea
vomiting
167
mcburneys point
right side of abdomen
| 1/3 distance from anterior superior ileac spine to umbilicus
168
appendix function
trap for heavy particles that are ingested
169
peritoneal status of colon sections
```
cecum- intra
ascending- retro
transverse- inta
descending- retro
sigmoid- intra
rectum/anal canal- retro
ALTERNATE
transverse and sigmoid have their own mesenteries
```
170
volvulus
a loop of bowel and mesentery abnormally twisted on itself
| cause obstruction and vascular ischemia
171
volvulus epidemiology
occurs most frequently in middle aged and elderly men
| 2-3/100,000 people per year
172
most common volvulus
sigmoid volvulus most common (8% of all intestinal obstructions)
cecum second
173
treatment for sigmoid volvulus
sigmoidoscopy
| barium enema
174
perianal abscess
pus accumulation in the ischioanal fossa
175
cryptitis
inflammation of anal sinuses
176
anal fissure
slit like lesion
12 o clock below anal valves
once one develops, internal anal sphincter goes into spasm, causing further separation of the tear constricting blood flow in the area, impairing healing, and causing pain
177
anal fistula
channel connects anal canal and perianal abscess
178
hemorrhoids
4-5% of the population with peal incidence from 45-65 yo
internal - above pectinate line (painless)
external - below pectinate line (painful)
179
diverticulosis
```
external evagination (out pocketing) of colon mucosa
mostly in middle aged or elderly
age dependent prevalence
85% in sigmoid colon
infection and rupture can happen
```
180
colectomy
removal of ileum, colon, rectum, and anal canal
181
ileostomy
establish an opening between the ileum and the skin
182
colostomy
establish an opening between the colon and the skin
183
sigmoidostomy
establish an opening from the sigmoid to the skin
184
colonoscopy
endoscopic exam of large bowel and distal part of small intestine with a CCD camera
visual diagnosis of ulceration and polyps
biopsy/removal of suspected colorectal cancer lesions
185
colonoscopy complications
1/200 have a serious complication
1/2000 perforations
2.6/1000 bleeding
3/100000 death
186
causes of upper GI bleeding
esophageal varices
| gastric or duodenal ulcer
187
causes of lower GI bleeding
```
meckels diverticulum
crohns
colonic diverticulum
colorectal cancer
hemorrhoid
anal fissure
arteriovenous malformation
```
188
stats of lower GI bleeding causes
40% diverticuli
21% IBS
10-15% cancer, coagulopathy, anal disease
2% arteriovenous malformation
