Final Exam: Abdominal Cavity Flashcards
(131 cards)
1
Q
What two plans divide up the abdomen into four quadrats?
A
midsaggital plane and transumbilical plane
2
Q
If a patient claims of pain in his lower left quadrant, what viscera do you need to consider?
A
sigmoid colon, inferior descending colon, left ovary and fallopian tube, left ureter, left spermatic cord
3
Q
What parts make up the large intestine, in order?
A
- the ilium of the SI dumps into the LI, which begins with the cecum
- cecum -> ascending colon -> transverse colon -> descending colon -> sigmoid colon -> rectum
4
Q
Describe the flow of the small intestine.
A
1) duodenum comes off pylorus of the stomach; smallest and first part of the SI
2) jejunum
3) ilium
5
Q
Where would you find pain if a patient has a ruptured appendix?
A
right lower quadrant
6
Q
What contents make up the right upper quadrant?
A
right lobe of liver, gallbladder, superior ascending colon, pylorus of stomach, some duodenum, head of pancreas, right kidney, right transverse colon, right adrenal gland
7
Q
Which abdominal quadrant is the spleen in?
A
left upper quadrant
8
Q
Describe the fascia above and below the umbilicus. What layer continues as colles fascia, and where does this go?
A
- above: camper fascia (superficial fatty layer)
- below: camper fascia and scarpa fascia
• (scarpa = deep membranous layer that continues as colles fascia in perineal region)
9
Q
What is the superior bony marking of the abdominal wall?
A
xiphoid process and costal margin
10
Q
The linea alba is a fusion of what? What is the linea semilunaris?
A
- fusion between the right and left halves of the rectus sheath
- linea semilunaris = lateral border of rectus sheath
11
Q
T/F: Rectus abdominus is a major core stabilizer.
A
- false; doesn’t originate on thoracolumbar fascia so it’s not a core stabilizer
- external oblique doesn’t core stabilize either
12
Q
What actions does the internal abdominal oblique do?
A
- ipsilateral side bend
- ipsilateral trunk rotation
- bilateral trunk flexion
- eccentric extension
• external oblique does same, just contralateral rotation
13
Q
What muscle tenses the linea alba?
A
pyramidalis
14
Q
What way do the external oblique muscle fibers run?
A
same as external intercostals, inward like your hands in your pockets
15
Q
How do external and internal obliques rotate the trunk?
A
external contralateral rotation, internal ipsilateral rotation
16
Q
What muscles do the iliohypogastric and ilioinguinal nerves (L1 branches) help innervate?
A
internal obliques and transverse abdominus
17
Q
Which oblique is a very important core stabilizer?
A
transverse abdominus
18
Q
What is diastasis recti? What can cause it? How do we treat it?
A
- condition where the linea alba is stretched and abdominal wall is separated (rectus abdominus sides further apart, 2-3 finger breadths)
- poor ab strength or pregnancy can cause this
- treat with core stabilization
19
Q
What is the conjoint tendon?
A
lower part of transverse abdominus, joints with the internal oblique
20
Q
The inguinal ligament is a continuation of what? What is the lacunar ligament?
A
- continuation from aponeurosis of external oblique and attaches to pubic tubercle
- lacunar lig = medial, thicker part of inguinal ligament
21
Q
What muscle should be one of the first core contractors for movements such as vacuuming, reaching, etc? What muscle co-contracts with it?
A
transverse abdominus and multifidus
22
Q
The delayed onset of contraction for the transverse abdominus indicates what?
A
motor control deficit and inefficient muscle stabilization for spine
23
Q
What is the arcuate line, and why is it significant? What’s found above and below it?
A
- arcute line is the inferior marker of the rectus sheath; it’s the horizontal division between the umbilicus and pubic symphysis
- above line = rectus sheath
- below = no rectus sheath, just transversalis fascia
24
Q
What is the rectus sheath? How is it formed?
A
- fibrous compartment of the rectus abdominal muscle
- formed from the lateral abdominal muscles coming in and enclosing the rectus abdominus
25
T/F: Between the ASIS and pubis, there are still oblique muscles there forming the posterior wall.
false, all muscles form anterior wall between the ASIS and pubis area
26
What muscle splits to enclose the rectus abdominus?
internal oblique
27
What muscles form the anterior and posterior walls ABOVE the arcuate line? What about below the line?
ABOVE line:
- anterior = external oblique, half of internal oblique
- posterior = half of internal oblique, transverse abdominus
BELOW line:
- anterior = all muscles
- posterior = transversalis fascia
28
What nerve supplies the skin to the upper inguinal region?
iliohypogastric
29
What nerve supplies the skin over lower inguinal region to thigh?
ilioinguinal
30
What makes the border of the lumbar triangles? Why are these potential sites for herniation?
- borders = latissimus dorsi, iliac crest, external oblique
| - not much muscle in the triangle, so viscera can get pushed through
31
What abdominal muscles attach onto the thoracolumbar fascia?
transverse abdominus and internal obliques (lats and multifidus do as well)
32
What is the nerve supply for the abdominal region?
thoracoabdominal nervers, ilioinguinal, and iliohypogastric
33
T/F: External oblique attaches on the thoracolumbar fascia.
false
34
What's the strongest layer of the thoracolumbar fascia and where is it found? What does it insert on?
- posterior layer is strongest, found superficial to erector spinae
- surrounds erector spinae and multifidus
- inserts on SI ligaments, sacral crest, and sacrotuberous ligament
35
Discuss the three layers of the thoracolumbar fascia.
1) anterior layer: in front of quadratus lumborum
2) middle layer: between quadratus lumborum and erector spinae
3) posterior layer: behind erector spinae
36
How is the iliolumbar ligament formed?
via thickening of the anterior layer of the thoracolumbar fasica
37
During fetal development, what are the walls of the inguinal canal made up of?
abdominal muscles
38
What causes the testes to drop and when?
In the 5th week of development, there's a surge of hormones that cause the testes to drop from posterior abdominal wall because it's too warm
39
What tugs on the testes to pull them down?
gubernaculum pulls them through inguinal canal
40
The testes are originally fixed on the posterior abdominal wall by what ligament?
suspensatory (diaphragmatic) ligament
41
What is the opening to the inguinal canal called? What's the entryway?
deep ring is the opening to the inguinal canal, and through the transversalis fascia is the entryway
42
What is the spermatic cord?
the cord of nerves, lymphs, vessels, and muscles brought down with the descention of the testes
43
What is the exit point of the inguinal canal, and what is the exitway?
exit point is superficial ring via the aponeurosis of external oblique muscle
44
T/F: Layers of the abdominal wall are brought down as the testes descend.
true
45
Explain the path the testes take when they descend.
- tugged by gubernaculum through the deep ring (via transversalis fascia) and then through the superficial ring (via aponeurosis of ext. oblique) and into the scrotum
46
What's the path of the round ligament for females?
ligaments begins at uterus, pierces through deep ring, exits via superficial ring and inserts on the labia majora
47
What are potential sites for hernias discussed in this chapter?
- diastisis recti
- lumbar triangles
- deep and superficial inguinal rings
48
Where is the deep ring located?
halfway between ASIS and pubic symphysis
49
T/F: The deep ring lies medial to the inferior epigastric artery.
- false, lies lateral
| - the SUPERFICIAL ring lies medial to the inf. epigastric a.
50
Where is the superficial ring located?
slightly above and lateral to pubic tubercle
51
What is the lacunar ligament?
thickening of the external oblique aponeurosis; attaches to pubic tubercle
52
What does the cremastor muscle do? What's it innervated by?
- draws testes up to protect them from cold
| - supply = genital branch of genital femoral a.
53
What is cut in a vasectomy?
vas deferens; they carry sperm from testes to seminal vessicles
54
T/F: The vas deferens is not a part of the spermatic cord.
false, it is
55
T/F: Direct/ indirect hernias can be classified as either inguinal or femoral hernias.
false, direct and indirect hernias are strictly INGUINAL hernias
56
Ovarian and gonadal arteries are direct branches of what?
abdominal aorta
57
Describe how the testicular/ovarian veins drain.
- L. testicular vein drains into L. renal vein
- R. testicular vein drains into IVC
(same goes for ovarian veins)
58
Where are femoral and inguinal hernias located? Which gender has which kind of hernia?
```
femoral = below and lateral to pubic tubercle (female)
inguinal = above and medial to pubic tubercle (male)
```
59
What are the qualifications for a direct and indirect inguinal hernia?
DIRECT
- dives straight into inguinal canal, only goes through superficial ring
- medial to the inf. epigastric a.
INDIRECT
- must pass through deep ring
- lateral to the inf. epigastric a.
60
What are the common causes for the direct and indirect hernias?
1) direct = superficial ring; weak ab wall, mostly in older men
2) indirect = deep ring; congenital weakness in inguinal canal
61
Name the contents of the spermatic cord.
- testicular v.
- vas deferens & its arteries
- genital branch of genital femoral a.
62
Which hernia protrudes through Hasselbach's triangle?
(inguinal triangle) so, direct inguinal hernia does
63
What are the boundaries of Hasselbach's, or inguinal, triangle?
1) lateral border of rectus abdominus
2) inferior epigastric vessels
3) inguinal ligament
64
Where is the direct hernia in regards to the inferior epigastric a.?
direct = medial to inf. epigastric a.
65
Where will you find an epigastric hernia? Why are they caused?
between xiphoid process and umbilicus; common from obesity
66
Abdominal viscera still piercing through in an infant is an example of what kind of hernia?
umbilical hernia
67
What are the three divisions of the gut?
foregut, midgut, hindgut
68
What are the contents of the foregut?
"Some Prefer Good Liquor Some Like Dirty martinis"
```
Stomach
Pancreas
Gallbladder
Liver
Spleen
Lower end of esophagus
Duodenum (1st part)
```
69
What are the innervations of the gut?
- fore and mid = vagus
- hind = pelvic splanchnic
- sympathetic fibers throughout, off lateral horns
70
What is the blood supply for the gut?
```
fore = celiac artery
mid = superior mesenteric a.
hind = inferior mesenteric a.
```
71
In which gut division would you find most of the small intestine?
midgut
72
In which gut division would you find the spleen?
foregut
73
What enlarges through the physiologic herniation during embryological development?
- liver englarges and the midgut herniates through the umbilicus, but then the liver reduces in size and it unherniates
- if that doesn't happen, the baby is born with its organs still outside
74
How do the curvatures of the stomach form?
From the midgut rotating around the superior mesenteric a., taking the stomach with it and creating curvatures
75
What portion of the duodenum unites with the jejunum?
ascending
76
In what 3 areas can hernias develop on wall?
umbilical, epigastric, inguinal
77
How can the transverse abdominus be a cause of low back pain?
if it's not contracting prior to movement, it's not protecting and stabilizing spine, so poor performance of this muscle can cause low back pain
78
Pelvic splanchnic innervates what part of the gut?
hindgut (vagus does the fore and mid)
79
T/F: Spleen is posterior to stomach and lateral to kidney.
true
80
Where are the adrenal glands and what do they do?
sit atop the kidney and secrete norepi and epi and cortisol
81
Where is bile stored? What's its path into the small intestine?
- stored in liver
- goes from liver to gallbladder via hepatic duct
- released via bile duct into the duodenum
82
If the patient experiences pain when the iliopsoas muscle contracts, what organs lie near this muscle to raise concern?
appendix
83
Where do the kidneys lie? Why is this important?
posterior abdominal wall from T12-L3; could be reason for back pain and be tender to palpate
84
Where is the esophageal opening?
T10
85
When the stomach slips through the diaphragm, what is this called?
hiatal hernia
86
What does the hindgut contain?
"Descending RATS"
```
Descending colon
Rectum
Anus
Transverse colon (distal 1/3)
Sigmoid colon
```
87
What innervates the hindgut?
pelvic splanchnic and sympathetic fibers from lateral horns
88
What is the blood supply to the stomach?
celiac trunk
89
What is a common cause of peptic ulcers?
h pyloric bacterium, so need to take antibiotic
90
What does rebound tenderness indicate?
- something wrong in the parietal layer
| pain when rebounding touch from abdomen
91
T/F: Mesentary/omentum is attached to the stomach and can wall off infection.
true; greater at greater curviture, lesser at lesser curviture
92
In what part of the intestine does most absorption take place?
jejunum
93
How long does it take food to pass through the SI?
4-5 hours
94
What levels of the spine does the duodenum span?
L1-3
95
What portion of the duodenum communicates with the stomach?
superior portion (1)
96
Which part of the duodenum has little holes for ducts of pancreas and bile duct?
descending portion (2)
97
What branches off the celiac a.?
splenic a., hepatic a., left gastric a.
98
In what quadrant does the ilium enter into the secum?
lower right quadrant
99
What intestine has longitudinal bands and haustra?
long intestine
100
Where is most water absorbed in digestion?
LI
101
How long does it take for stool to pass through and water to be absorbed?
32 hours
102
What is diverticulosis?
inflammed pouches/lining in the LI
103
What does the spleen do? At what vertebral level is it found?
- cleans up blood, but we can live without it
| - at ribs 9-11
104
Explain where the spleen is in relation to the diaphragm and kidney and stomach.
- stomach lies on top of spleen
- spleen is lateral to kidney
- diaphragm is behind spleen
- tail of pancreas is at medial hylum of spleen (pancreas is behind stomach)
105
T/F: Pancreas is only an exocrine gland.
false, endocrine and exocrine
106
What does the pancreas release?
insulin and glucagon to control blood glucose
107
What is the uncinate process of the pancreas?
beginning of pancreas, followed by head, neck, body, and tail
108
What does the coronary ligament of the diaphragm do?
attaches the diaphragm to the liver
109
What is the largest gland in the body?
liver
110
Where does the liver get its blood supply?
portal vein and hepatic artery
111
Where are vitamin A and glycogen stored?
in the liver
112
What makes up the portal triad?
bile duct, hepatic artery, portal vein
113
What is the left sagittal fissure of the liver formed by?
the ligamentum venosum (used to be ductus venosus)
114
T/F: The portal triad can be found in the left sagittal fissure.
false, found in the transverse fissure
115
Discuss the path of bile.
made and stored in liver until needed to emulsify fats in digestion, then travels to gallbladder via hepatic duct and then released to duodenum via cystic duct
116
Where's the opening for the IVC in the diaphragm? Where's the aortic hiatus?
IVC = T8
| aortic hiatus = T12
117
What are the actions of quadratus lumborum?
bilateral extension, ipsilateral flexion, fixes 12th rib
118
What can cause gallstones?
Bile can become a stone wedged in the duct and gallbladder gets inflammed
119
What three areas can constrict the ureter?
1) renal pelvis
2) brim
3) bladder
120
T/F: Ureters can cause referred pain from loin to groin.
true
121
What nerve roots make up the lumbar plexus? What nerves?
```
L1-5
• iliohypogastric/ ilioinguinal = L1
• genitofemoral = L1-2
• lateral cutaneous nerve to thigh = L2-3
• femoral and obturator = L2-4
```
122
T/F: Lateral cutaneous nerve to thigh runs over the inguinal ligament.
false, passes deep to it
123
What structure overlies the renal vein?
SMA
124
How does an anneurism occur? Where do they typically develop?
- aterial walls weaken and blood wells up, can cause artery to rupture and for the patient to bleed out
- typically develop below renal artery, right above bifurcation
125
What is the blood supply for the adrenal gland?
renal a.
126
T/F: Suprarenal, renal, and gonadal arteries are all directly off the abdominal aorta.
true
127
What veins create the portal vein?
superior mesenteric and splenic veins
128
Explain drainage of excess water/salts in the kidney.
drains into pyramids -> callyces -> major callyces -> renal pelvis
129
What is meralgia parasthetica?
extra fat impinging the lateral cutaneous nerve to thigh in obese people
130
What causes caput medusae?
anastemosis between the portal vein and the umbilical region; liver engorges and blood backs up into the umbilical region
131
What 4 areas anastemose or communicate with the portal vein system?
1) rectum (causing hemrrhoids)
2) lower esophagus
3) periumbilical region
4) abdominal viscera (duodenum/pancreas)
