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Semester 4: Nutrition and Metabolism > Anatomy Topic 4 Case 1 > Flashcards

Anatomy Topic 4 Case 1 Flashcards

1
Q

Describe the protective role of the abdomen

A
  • Abdomen houses elements of the GI tract, spleen and urinary system
  • Much of the viscera is under the diaphragm and is protected by the thoracic wall
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2
Q

Describe the abdomen’s role in inspiration

A
  • Abdominal muscles relaxes
  • To accommodate expansion of the thoracic cavity
  • To cause inferior displacement of abdominal organs during contraction of diaphragm
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3
Q

Describe the abdomen’s role in expiration

A
  • Abdominal muscles contract
  • To assist in elevating the domes of the diaphragm
  • Reducing thoracic volume
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4
Q

How is intraabdominal pressure increased and what is the purpose of this.

A
  • Contraction of abdominal wall muscles

- Assisting in voiding the contents of the bladder, rectum and in giving birth

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5
Q

Which planes form the four-quadrant pattern

A
  • Transumbilical plane passing through umbilicus at the level of L3/L4
  • Vertical median plane passing in the mid-sagittal plane
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6
Q

Which planes form the nine-quadrant pattern?

A
  • Subcostal plane at the level of L3 / rib 10
  • Intertubercular plane connecting tubercles of iliac crests and L5
  • Midclavicular planes passing in the sagittal plane between the midpoint of the clavicle and
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7
Q

Identify the nine regions of the abdomen

A
  • Right and left hypochdonrium, separated by epigastric region
  • Right and left flank, separated by umbilical region
  • Right and left groin, separated by the pubic region.
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8
Q

Where is a craniocaudal incision performed and what is the purpose?

A
  • Incision from xiphoid process to pubic symphysis

- Provides access to whole of abdominal contents for an exploratory procedure

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9
Q

What is laparoscopic surgery? Identify an advantage of this type of surgery

A
  • Keyhole surgery through small incisions no more than 2cm in length
  • Less postoperative pain and shorter recovery times
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10
Q

What are the palpable landmarks used to delineate the extent of the abdomen?

A
  • Costal margin above

- Pubic tubercle and ASIL above

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11
Q

A line between which structures marks the position of the inguinal ligament? What is the purpose of the inguinal ligament?

A
  • Pubi tubercle and ASIL

- Separates anterior abdominal wall above from thigh below

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12
Q

What is the superficial inguinal ring and where is it located?

A
  • Triangular defect in aponeurosis of external oblique
  • External opening of inguinal canal
  • In lower medial aspect of anterior abdominal wall
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13
Q

What passes through the superficial inguinal ring in men?

A
  • Spermatic cord
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14
Q

What passes through the superficial inguinal ring in women?

A
  • Round ligament of uterus
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15
Q

What is the deep inguinal ring and where is it located?

A
  • Internal opening to inguinal canal

- Superior to inguinal ligament midway between ASIL and pubic symphysis

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16
Q

Where can the femoral pulse be felt?

A
  • Inferior to inguinal ligament

- Midway between ASIL and pubic symphysis

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17
Q

Where is the transpyloric plane located?

A
  • L1 / rib 9 level
  • Transverse plane
  • Midway between jugular notch and pubic symphysis
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18
Q

Where is the supracristal plane located

A
  • L4
  • Transverse plane
  • Through highest point of iliac crests
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19
Q

Identify structures found at the level of L1 / transpyloric plane

A
  • Upper limit of end of duodenum
  • Hila of kidneys
  • Neck of pancreas
  • Origin of superior mesenteric artery
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20
Q

Which major blood vessel originates at the upper border of L1?

A
  • Celiac trunk
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21
Q

Which major blood vessel originates at the lower border of L1?

A
  • Superior mesenteric artery
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22
Q

Which major blood vessel originates at the lower border of L2?

A
  • Renal arteries
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23
Q

Which major blood vessel originates at the lower border of L3?

A
  • Inferior mesenteric artery
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24
Q

Which major blood vessel originates at the lower border of L4?

A
  • Common iliac arteries
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25
Q

Which major blood vessel originates at the lower border of L5?

A
  • Inferior vena cava from right and left common iliac veins
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26
Q

Which organs are in the right upper quadrant?

A
  • Liver and gallbladder
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27
Q

Which organs are in the left upper quadrant?

A
  • Stomach and spleen
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28
Q

Which organs are in the right lower quadrant?

A
  • Cecum and appendix
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29
Q

Which organs are in the left lower quadrant?

A
  • Descending and sigmoid colon
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30
Q

How can the inferior of the liver be palpated?

A
  • Just below right costal margin when patient breathes in deeply
  • Can be felt slipping under palpating fingers
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31
Q

Where is McBurney’s point and what is it used to identify?

A
  • One-third the way up a line from right ASIL to umbilicus

- Common surface projection of the appendix

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32
Q

The superior poles of the kidneys reach as high as which ribs?

A
  • Left: 11

- Right: 12

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33
Q

At which vertebral level are the inferior poles of the kidneys?

A
  • L3/L4
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34
Q

At which vertebral level are the hila of the kidneys?

A
  • L1
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35
Q

With relation to surface anatomy where is the spleen located?

A
  • Left side and back in the area of ribs 9 to 11
  • Follows the counter of rib 10 and extends from the superior pole of the left kidney to just posterior to the midaxillary line
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36
Q

Identify the boundaries of the abdominal wall

A
  • Superiorly by xiphoid process and costal margins
  • Posterior by vertebral column
  • Inferiorly by pelvic bones
37
Q

Identify the layers of the abdominal wall

A
  • Skin
  • Superficial fascia
  • Muscles and their fascia
  • Extraperitoneal fascia
  • Parietal peritoneum
38
Q

What is Camper’s fascia?

A
  • Superficial fatty layer of superficial fascia
  • Continuous with the superficial fascia of the thigh
  • Forms dartos fascia in men
  • Forms labia majora in women
39
Q

What is Scarpa’s fascia?

A
  • Deep membranous layer of superficial fascia

- It is continuous with the fascia lata in the thigh

40
Q

What is Colles’ fascia?

A
  • Part of Scarpa’s fascia that is firmly attached to ischiopubic rami and posterior margin of perineal membrane
41
Q

How does Scarpa’s fascia differ in males and females?

A
  • Males: blends with superficial layer to form dartos fascia, also forms fundiform ligament of penis
  • Women: forms labia majora
42
Q

Identify the five anterolateral muscles

A
  • External oblique
  • Internal oblique
  • Transversus abdominis
  • Rectus abdominis
  • Pyramidalis
43
Q

Identify the combined actions of the anterolateral muscles

A
  • Protection of the viscera
  • Maintains position of the viscera
  • Quiet and forced expiration
  • Increases intraabdominal pressure
44
Q

Identify the origin, insertion, action and innervation of the external oblique muscle

A
  • Origin: Slips from outer surfaces of ribs 5-12
  • Insertion: Lateral lip of iliac crest, aponeurosis ending in linea alba
  • Innervation: Anterior rami of T7-T12
  • Function: Flexion of trunk, turning anterior part of abdomen to opposite side, compressing abdominal contents
45
Q

Identify the role of the external oblique in the formation of the inguinal canal

A
  • Lower border of the external oblique aponeurosis forms the inguinal ligament
  • Which folds under itself forming a trough
46
Q

Where does the lacunar ligament form between?

A
  • Medial end of inguinal ligament

- Pectin pubis

47
Q

Identify the origin, insertion, action and innervation of the internal oblique

A
  • Origin: Thoracolumbar fascia, iliac crest between origins of external oblique and transversus, lateral 2/3 of inguinal ligament
  • Insertion: Inferior border of ribs 8 to 12, aponeurosis ending in linea alba, pubic crest and pectineal line
  • Innervation: Anterior rami of T7 to L1
  • Function: Flexion of trunk, turning anterior part of abdomen to opposite side, compressing abdominal contents
48
Q

Identify the origin, insertion, action and innervation of the transversalis abdominis muscle

A
  • Origin: Thoracolumbar fascia, medial lip of iliac crest, lateral 1/3 of inguinal ligament, costal cartilages of ribs 7 to 12
  • Insertion: Aponeurosis ending in linea alba
  • Innervation: T7 to L1
  • Action: Compresses abdominal contents
49
Q

Identify the origin, insertion, action and innervation of rectus abominis

A
  • Origin: Pubic crest, tubercle and symphysis
  • Insertion: Costal cartilages of ribs 5-7, xiphoid process
  • Innervation: T7-T12
  • Function: Compresses abdominal wall, flexion of vertebral column, tenses abdominal wall
50
Q

Identify the origin, insertion, action and innervation of pyramidalis

A
  • Origin: Front of pubic symphysis
  • Insertion: Linea alba
  • Innervation: Anterior ramus of T12
  • Function: Tenses linea alba
51
Q

What is the transversalis fascia?

A
  • Layer of deep investing fascia associated with the transversalis muscle
  • That lines the abdominal fascia
  • Continuous posteriorly with thoracolumbar fascia
  • Blends anteriorly with fascia covering pelvic bones to form the parietal pelvic fascia
52
Q

Where is the extraperitoneal fascia located, where is it most prominent and what does it contain?

A
  • Deep to transversalis fascia and superficial to peritoneum
  • More prominent posteriorly (retroperitoneal)
  • Contains blood vessels
53
Q

What is the peritoneum. Where is it located and how does it differ in males and females?

A
  • Thin serous membrane that lines the abdominal walls and reflects onto viscera
  • Deep to extraperitoneal fascia
  • Closed in men, has two openings in women for passage of uterine tubes
54
Q

Identify the arterial supply to the superficial superior part of the anterior abdominal wall

A
  • Musculophrenic artery

- The terminal branch of the internal thoracic artery

55
Q

Identify the arterial supply to the superficial inferior part of the anterior abdominal wall

A
  • Medially by the superficial epigastric artery
  • Laterally by the superficial circumflex iliac artery
  • Both of which are branches of the femoral artery
56
Q

Identify the arterial supply to the deep superior part of the anterior abdominal wall

A
  • Superior epigastric artery

- A terminal branch of the internal thoracic artery

57
Q

Identify the arterial supply to the deep lateral part of the anterior abdominal wall

A
  • Tenth and eleventh intercostal arteries

- Subcostal artery

58
Q

Identify the arterial supply to the deep inferior part of the anterior abdominal wall

A
  • Medially by the inferior epigastric artery
  • Laterally by the deep circumflex iliac artery
  • Both of which are branches of the external iliac artery
59
Q

Which arteries enter the rectus sheath and anastomose?

A
  • Superior and inferior epigastric arteries
60
Q

Which intercostal nerves are involved in innervation of the anterolateral abdominal wall

A
  • T7 to T11
61
Q

Outline the pathway of the intercostal nerves supplying the anterolateral abdominal wall

A
  • Leave intercostal spaces
  • Pass deep to costal cartilage
  • Continue between internal oblique and transversus abdominis muscles
  • Enter rectus sheath, posterior to lateral aspect of rectus abdominis
  • Approach midline and give off an anterior cutaneous branch
62
Q

Other than the intercostal nerves, identify three other nerves supplying the anterolateral abdominal wall and their course

A
  • Subcostal nerve (T12) follows similar course as intercostals
  • Iliohypogastric and ilioinguinal nerves (L1) branch from lumbar plexus
63
Q

Which region of skin is supplied by T7-T9?

A
  • Skin from xiphoid process to just above umbilicus
64
Q

Which region of skin is supplied by T10?

A
  • Umbilicus
65
Q

Which region of skin is supplied by T11-L1

A
  • Below umbilicus including pubic region

- Ilioinguinal nerve also supplies anterior surface of scrotum, labia majora, and small part of proximal thigh

66
Q

Outline the superficial lymphatic drainage of the anterior abdominal wall

A
  • Above umbilicus: Axillary nodes

- Below umbilicus: Superior inguinal nodes

67
Q

Outline the deep lymphatic drainage of the anterior abdominal wall

A
  • Parasternal nodes along internal thoracic artery
  • Lumbar nodes along the abdominal aorta
  • External iliac nodes along the external iliac artery
68
Q

At which vertebral levels does the oesophagus start and finish?

A
  • C6 superiorly

- T11 inferiorly

69
Q

Outline the pathway taken by the oesophagus

A
  • Descends on anterior bodies of vertebrae
  • Moves anteriorly and slightly left as it approaches the diaphragm
  • Passes through oesophageal hiatus at T10
70
Q

Which structure passes posterior to the oesophagus?

A
  • Thoracic duct
  • Right side inferiorly
  • Crosses superiorly onto left side
71
Q

Which structure passes anterior to the oesophagus?

A
  • Right pulmonary artery and left main bronchus at tracheal bifurcation
72
Q

At which locations can the trachea be narrowed by surrounding structures? What is the clinical significance of this?

A
  • Junction of oesophagus with pharynx
  • Superior mediastinum where it is crossed by aortic arch
  • Posterior mediastinum where it is compressed by left main bronchus
  • Posterior mediastinum at oesophageal hiatus in the diaphragm
  • Swallowed object is most likely to lodge at a constricted area, causing more damage at this site than elsewhere along the oesophagus.
73
Q

What is the abdominal oesophagus? Where does it emerge and pass between?

A
  • Short distal part of diaphragm
  • Right crus at T10
  • Passes from oesophageal hiatus to cardiac orifice
74
Q

Outline the arterial supply to the thoracic oesophagus

A
  • Oesophageal arteries (from aorta)
  • Bronchial artereis
  • Ascending branches of left gastric artery (from celiac trunk)
75
Q

Outline the arterial supply to the abdominal oesophagus

A
  • Oesophageal branches from left inferior phrenic artery (from aorta)
76
Q

Outline the venous drainage of the oesophagus

A
  • Small vessels to azygos vein
  • Small vessels to hemiazygos vein
  • Oesophageal branches to left gastric vein
77
Q

Outline the lymphatic drainage of the oesophagus

A
  • Posterior mediastinal nodes

- Left gastric nodes

78
Q

Identify the sensory innervation of the oesophagus

A
  • Visceral afferents from vagus nerves, sympathetic trunks and splanchnic nerves
79
Q

What is the oesophageal plexus?

A
  • Right and left vagus nerves give off branches forming oesophageal plexus
  • Just above diaphragm many fibres converge
  • To form anterior vagal trunk on anterior surface of oesophagus (mainly from left vagus nerve)
  • And posterior vagal trunk on posterior surface of oesophagus (mainly from right vagus nerve)
80
Q

What type of epithelia lines the lumen of the oesophagus?

A
  • Stratified squamous
81
Q

What is contained within the underlying lamina propria of the oesophagus?

A
  • Lymphoid aggregates
82
Q

What is contained within the submucosa of the oesophagus?

A
  • Elastin fibres allowing for distension

- Seromucinous glands which aid lubrication and are most prominent in the upper and lower thirds

83
Q

Identify the two layers of muscle in the muscularis propria?

A
  • Outer longitudinal fibres

- Inner circular fibres

84
Q

What is Barret’s oesophagus?

A
  • Epithelium in lower oesophagus undergoes metaplasia
  • From stratified squamous epithelia to columnar-mucus secreting epithelia
  • High risk of developing dysplasia and invasive adenocarcinoma
85
Q

Identify the four distinct functional layers of the GI tract

A
  • Mucosa: Epithelia, lamina propria, muscularis mucosa
  • Submucosa: contains blood vessels, lymphatics and nerves
  • Muscularis propria (outer longitudinal, inner circular fibres)
  • Adventitia: loose supporting tissue that conducts vessels, nerve and adipose tissue.
86
Q

What is the rectus sheath?

A
  • Sheath that encloses the rectus abdominis and pyramidalis

- Composed of the aponeurosis of the external and internal oblique, and the transversus abdominis muscle

87
Q

Describe the arrangement of the rectus sheath in the upper three quarters of the rectus abdominis

A
  • Anterior wall from external oblique and half of internal oblique
  • Posterior wall from half of internal oblique and the transversus abdominis
88
Q

Describe the arrangement of the rectus sheath in the lower quarters of the rectus abdominis

A
  • Anterior wall from aponeurosis of all three muscles

- No posterior wall

89
Q

What is the arcuate line and what is its position?

A
  • Point of transition of rectus sheath

- Halfway between umbilicus and pubic symphysis

Semester 4: Nutrition and Metabolism (17 decks)

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